Implementation of mothers2mothers’ active client follow-up (ACFU) pilots has now been completed in Zambia and Malawi and m2m is in the process of analyzing a wealth of qualitative and quantitative data. The key objective of these pilots has been to look at the acceptability, feasibility and effectiveness of ACFU in the contexts in which m2m is working, in order to promote the best possible approaches to encourage women who miss key PMTCT appointments to return to the health facility for care.
Alongside this key objective has been a desire to understand better why clients miss priority PMTCT appointments. Quantitative data shows that a fair proportion of clients reported back that they were busy other things. Further probing in focus group discussions with m2m’s Mentor Mothers complemented this finding, as the perceived importance of PMTCT services was revealed as low, as well as a lack of adequate information provided at routine appointments. This points to the critical role m2m and facility staff must continue to play in emphasizing to clients the importance of returning for care.
Forgetting an appointment was also fairly common. Where cell phone technology is deemed to be a feasible approach for contacting clients in particular settings, the possibility of sending pre-appointment reminders to address this challenge could be further explored.
Non-acceptance of one’s HIV positive status was also cited as a common reason for not coming back to the facility for PMTCT services. As one participant explains;
A certain young woman aged 18 who underwent CD4 count could not come back to the facility to receive her results. When we followed her up, she came back but could not get in the queue to get her results as she had seen someone she knew. Whilst she waited for that person to go, she then saw her sister. The young woman kept on hiding, till later on during that day when she was sure that no one was watching her, managed to get her CD4 results.
With clients who have not disclosed to close family members finding it extremely difficult to confront the issue of HIV and seek further help, m2m continues to be in a key position to support clients in this process. Assisting clients to disclose will in turn promote adherence to follow-up appointments and ongoing PMTCT care and support.
As well as learning how best to integrate ACFU into m2m programming, by looking closely at why women miss appointments in the first place, m2m is provided with the opportunity to positively address some of these key reasons in our everyday work at the facility level.