Abstract

Background: Informal healthcare providers are key actors in the provision of healthcare among poor populations in developing countries. In 2017, Cameroon had more than 3,000 informal health facilities. In a context of elimination of mother-to-child transmission of HIV, this study described the offer of Prevention of Mother to Child Transmission of HIV (PMTCT) in informal health centers in Cameroon.

Methods: This two-phase cross-sectional study was conducted in two cities, Douala and Ebolowa, in Cameroon. The first phase was conducted from March to July 2019 in 110 informal healthcare centers and the second phase was conducted from August 2019 to January 2020 with 183 Healthcare Providers (HPs) in these facilities. Standardized questionnaires were administered and data was entered into koboCollect software. Descriptive statistics and logistic regression were used with a P <0.05 considered significant.​​​

Results: A total of 109 of the 110 informal healthcare centers integrated HIV testing into their antenatal check-up packages. Of these, 43% (47/109) reported providing antiretroviral treatment to HIV-infected pregnant women, while the remaining referred these women to formal HIV care centers. Of 101 informal healthcare centers that offered childbirth services, 54%(55/101) referred HIV-exposed newborns to further PMTCT care. More than half of the HPs (51%; 94/183) had insufficient PMTCT knowledge and 90% (165/183) had an insufficient PMTCT practice level. The lack of PMTCT experience (adjusted odds ratio (aOR)=32.04, 95% CI: 6.29-163.10, p <0.001) and PMTCT training during the prior two years (aOR=3.02, 95% CI: 1.06-8.64, p=0.03) increased the chance of having insufficient knowledge of PMTCT in HPs. While working in IHCs that referred women for PMTCT (aOR=4.1, 95%CI: 1.18 à 14.13, p=0.02) increased their odds of having insufficient PMTCT practices..

Conclusion: Informal healthcare centers in Cameroun often perform illegal PMTCT activities. Given the low PMTCT knowledge and practices of healthcare providers in these informal healthcare centers, the national PMTCT program would benefit from the use of strategies to assure the safe care of HIV-positive pregnant women who are clients of these informal healthcare structures.