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Ngandu NK, Maduna V, Sherman G, Noveve N, Chirinda W, Ramokolo V, Lombard C, Goga AE. Infrastructural and human-resource factors associated with return of infant HIV test results to caregivers: secondary analysis of a nationally representative situational assessment, South Africa, 2010. BMC Infect Dis 2019; 19:785. [PMID: 31526381 PMCID: PMC6745768 DOI: 10.1186/s12879-019-4337-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background In June 2015, South Africa introduced early infant HIV diagnosis (EID) at birth and ten weeks postpartum. Guidelines recommended return of birth results within a week and ten weeks postpartum results within four weeks. Task shifting was also suggested to increase service coverage. This study aimed to understand factors affecting return of EID results to caregivers. Methods Secondary analysis of data gathered from 571 public-sector primary health care facilities (PHCs) during a nationally representative situational assessment, was conducted. The assessment was performed one to three months prior to facility involvement in the 2010 evaluation of the South African programme to prevent mother-to-child HIV transmission (SAPMTCTE). Self-reported infrastructural and human resource EID-related data were collected from managers and designated staff using a structured questionnaire. The main outcome variable was ‘EID turn-around-time (TAT) to caregiver’ (caregiver TAT), measured as reported number of weeks from infant blood draw to caregiver receipt of results. This was dichotomized as either short (≤3 weeks) or delayed (> 3 weeks) caregiver TAT. Logit-based risk difference analysis was used to assess factors associated with short caregiver TAT. Analysis included TAT to facility (facility TAT), defined as reported number of weeks from infant blood draw to facility receipt of results. Results Overall, 26.3% of the 571 PHCs reported short caregiver TAT. In adjusted analyses, short caregiver TAT was less achieved when facility TAT was > 7 days (versus ≤7 days) (adjusted risk difference (aRD): − 0.2 (95% confidence interval − 0.3-(− 0.1)), p = 0.006 for 8–14 days and − 0.3 (− 0.5-(− 0.1)), p = 0.006 for > 14 days), and in facilities with staff nurses (compared to those without) (aRD: − 9.4 (− 16.6-(− 2.2), p = 0.011). Conclusion Although short caregiver TAT for EID was only reported in approximately 26% of facilities, these facilities demonstrate that achieving EID TAT of ≤3 weeks is possible, making timely ART initiation within 3 weeks of diagnosis feasible within the public health sector. Our adjusted analyses underpin the need for quick return of results to facilities. They also raise questions around staff mentoring: we hypothesise that facilities with staff nurses were likely to have fewer professional nurses, and thus inadequate senior support. Electronic supplementary material The online version of this article (10.1186/s12879-019-4337-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nobubelo Kwanele Ngandu
- Health Systems Research Unit, South, African Medical Research Council, Cape Town, SA, South Africa.
| | - Vincent Maduna
- Health Systems Research Unit, South, African Medical Research Council, Cape Town, SA, South Africa
| | - Gayle Sherman
- Centre for HIV and STI, National Institute of Communicable Diseases, Johannesburg, SA, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, SA, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South, African Medical Research Council, Cape Town, SA, South Africa
| | - Witness Chirinda
- Health Systems Research Unit, South, African Medical Research Council, Cape Town, SA, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South, African Medical Research Council, Cape Town, SA, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, SA, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, SA, South Africa
| | - Ameena Ebrahim Goga
- Health Systems Research Unit, South, African Medical Research Council, Cape Town, SA, South Africa.,Department of Paediatrics, University of Pretoria, Pretoria, SA, South Africa
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Goga AE, Singh Y, Singh M, Noveve N, Magasana V, Ramraj T, Abdullah F, Coovadia AH, Bhardwaj S, Sherman GG. Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings. Matern Child Health J 2018; 21:1-8. [PMID: 27514391 PMCID: PMC5226975 DOI: 10.1007/s10995-016-2074-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Increasing access to HIV-related care and treatment for children aged 0–18 years in resource-limited settings is an urgent global priority. In 2011–2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.
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Affiliation(s)
- Ameena Ebrahim Goga
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
- Department of Paediatrics, University of Pretoria, Private bag X20, Hatfield, Pretoria, 0028, South Africa.
| | - Yagespari Singh
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Michelle Singh
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | - Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa
| | | | - Ashraf H Coovadia
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Gayle G Sherman
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute of Communicable Diseases, National Health Laboratory Services, Modderfontein Road, Sandringham, Johannesburg, South Africa
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Ramraj T, Jackson D, Dinh TH, Olorunju S, Lombard C, Sherman G, Puren A, Ramokolo V, Noveve N, Singh Y, Magasana V, Bhardwaj S, Cheyip M, Mogashoa M, Pillay Y, Goga AE. Adolescent Access to Care and Risk of Early Mother-to-Child HIV Transmission. J Adolesc Health 2018; 62:434-443. [PMID: 29269045 PMCID: PMC6004498 DOI: 10.1016/j.jadohealth.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/06/2017] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Adolescent females aged 15-19 account for 62% of new HIV infections and give birth to 16 million infants annually. We quantify the risk of early mother-to-child transmission (MTCT) of HIV among adolescents enrolled in nationally representative MTCT surveillance studies in South Africa. METHODS Data from 4,814 adolescent (≤19 years) and 25,453 adult (≥20 years) mothers and their infants aged 4-8 weeks were analyzed. These data were gathered during three nationally representative, cross-sectional, facility-based surveys, conducted in 2010, 2011-2012, and 2012-2013. All infants were tested for HIV antibody (enzyme immunoassay), to determine HIV exposure. Enzyme immunoassay-positive infants or those born to self-reported HIV-positive mothers were tested for HIV infection (total nucleic acid polymerase chain reaction). Maternal HIV positivity was inferred from infant HIV antibody positivity. All analyses were weighted for sample realization and population live births. RESULTS Adolescent mothers, compared with adult mothers, have almost three times less planned pregnancies 14.4% (95% confidence interval [CI]: 12.5-16.5) versus 43.9% (95% CI: 42.0-45.9) in 2010 and 15.2% (95% CI: 13.0-17.9) versus 42.8% (95% CI: 40.9-44.6) in 2012-2013 (p < .0001), less prevention of MTCT uptake (odds ratio [OR] in favor of adult mothers = 3.36, 95% CI: 2.95-3.83), and higher early MTCT (adjusted OR = 3.0, 95% CI: 1.1-8.0), respectively. Gestational age at first antenatal care booking was the only significant predictor of early MTCT among adolescents. CONCLUSIONS Interventions that appeal to adolescents and initiate sexual and reproductive health care early should be tested in low- and middle-income settings to reduce differential service uptake and infant outcomes between adolescent and adult mothers.
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Affiliation(s)
- Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Debra Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa,UNICEF, Health Section, New York, New York
| | - Thu-Ha Dinh
- Center for Global Health, Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steve Olorunju
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa,School of Public Health and Family Medicine, University of Cape Town, Cape Town South Africa
| | - Gayle Sherman
- Centre for HIV and STI, National Institute of Communicable Diseases, Johannesburg, South Africa,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Adrian Puren
- Centre for HIV and STI, National Institute of Communicable Diseases, Johannesburg, South Africa,Division of Virology and Communicable Diseases, School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Yages Singh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Mireille Cheyip
- Center for Global Health, Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mary Mogashoa
- Center for Global Health, Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Yogan Pillay
- National Department of Health, HIV/AIDS, TB & Maternal, Child, and Women’s Health, Pretoria, South Africa
| | - Ameena E. Goga
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa,Department of Paediatrics, University of Pretoria, Pretoria, South Africa
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Goga AE, Dinh TH, Jackson DJ, Lombard CJ, Puren A, Sherman G, Ramokolo V, Woldesenbet S, Doherty T, Noveve N, Magasana V, Singh Y, Ramraj T, Bhardwaj S, Pillay Y. Population-level effectiveness of PMTCT Option A on early mother-to-child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT. J Glob Health 2017. [PMID: 27698999 PMCID: PMC5032343 DOI: 10.7189/jogh.6.020405] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Eliminating mother–to–child transmission of HIV (EMTCT), defined as ≤50 infant HIV infections per 100 000 live births, is a global priority. Since 2011 policies to prevent mother–to–child transmission of HIV (PMTCT) shifted from maternal antiretroviral (ARV) treatment or prophylaxis contingent on CD4 cell count to lifelong maternal ARV treatment (cART). We sought to measure progress with early (4–8 weeks postpartum) MTCT prevention and elimination, 2011–2013, at national and sub–national levels in South Africa, a high antenatal HIV prevalence setting ( ≈ 29%), where early MTCT was 3.5% in 2010. Methods Two surveys were conducted (August 2011–March 2012 and October 2012–May 2013), in 580 health facilities, randomly selected after two–stage probability proportional to size sampling of facilities (the primary sampling unit), to provide valid national and sub–national–(provincial)–level estimates. Data collectors interviewed caregivers of eligible infants, reviewed patient–held charts, and collected infant dried blood spots (iDBS). Confirmed positive HIV enzyme immunoassay (EIA) and positive total HIV nucleic acid polymerase chain reaction (PCR) indicated infant HIV exposure or infection, respectively. Weighted survey analysis was conducted for each survey and for the pooled data. Findings National data from 10 106 and 9120 participants were analyzed (2011–12 and 2012–13 surveys respectively). Infant HIV exposure was 32.2% (95% confidence interval (CI) 30.7–33.6%), in 2011–12 and 33.1% (95% CI 31.8–34.4%), provincial range of 22.1–43.6% in 2012–13. MTCT was 2.7% (95% CI 2.1%–3.2%) in 2011–12 and 2.6% (95% CI 2.0–3.2%), provincial range of 1.9–5.4% in 2012–13. HIV–infected ARV–exposed mothers had significantly lower unadjusted early MTCT (2.0% [2011–12: 1.6–2.5%; 2012–13:1.5–2.6%]) compared to HIV–infected ARV–naive mothers [10.2% in 2011–12 (6.5–13.8%); 9.2% in 2012–13 (5.6–12.7%)]. Pooled analyses demonstrated significantly lower early MTCT among exclusive breastfeeding (EBF) mothers receiving >10 weeks ARV prophylaxis or cART compared with EBF and no ARVs: (2.2% [95% CI 1.25–3.09%] vs 12.2% [95% CI 4.7–19.6%], respectively); among HIV–infected ARV–exposed mothers, 24.9% (95% CI 23.5–26.3%) initiated cART during or before the first trimester, and their early MTCT was 1.2% (95% CI 0.6–1.7%). Extrapolating these data, assuming 32% EIA positivity and 2.6% or 1.2% MTCT, 832 and 384 infants per 100 000 live births were HIV infected, respectively. Conclusions Although we demonstrate sustained national–level PMTCT impact in a high HIV prevalence setting, results are far–removed from EMTCT targets. Reducing maternal HIV prevalence and treating all maternal HIV infection early are critical for further progress.
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Affiliation(s)
- Ameena E Goga
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Thu-Ha Dinh
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and Tuberculosis, Atlanta, GA, USA
| | - Debra J Jackson
- School of Public Health, University of the Western Cape, Cape Town, South Africa; UNICEF, New York, NY, USA
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian Puren
- Centre for HIV and STI, National Institute of Communicable Diseases, Johannesburg, South Africa; Division of Virology and Communicable Diseases, School of Pathology, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Gayle Sherman
- Centre for HIV and STI, National Institute of Communicable Diseases, Johannesburg, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Selamawit Woldesenbet
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa; Wits School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Yagespari Singh
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
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5
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Goga AE, Dinh T, Jackson DJ, Lombard CJ, Puren A, Sherman G, Ramokolo V, Woldesenbet S, Doherty T, Noveve N, Magasana V, Singh Y, Ramraj T, Bhardwaj S, Pillay Y. Population–level effectiveness of PMTCT Option A on early mother–to–child (MTCT) transmission of HIV in South Africa: implications for eliminating MTCT. J Glob Health 2016; 6:020405. [DOI: 10.7189/jogh.06.020405] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Besada D, Rohde S, Goga A, Raphaely N, Daviaud E, Ramokolo V, Magasana V, Noveve N, Doherty T. Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal. Glob Health Action 2016; 9:33507. [PMID: 27829490 PMCID: PMC5102106 DOI: 10.3402/gha.v9.33507] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol. Design Data were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country. Results Common strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups. Conclusions The approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted. A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.
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Affiliation(s)
- Donela Besada
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sarah Rohde
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ameena Goga
- Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Paediatrics, University of Pretoria, Pretoria, South Africa
| | - Nika Raphaely
- Health Systems Research Unit, South African Medical Research Council, Pretoria, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Emmanuelle Daviaud
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council, Durban, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, University of the Western Cape, Cape Town, South Africa;
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7
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Nkomo P, Davies N, Sherman G, Bhardwaj S, Ramokolo V, Ngandu NK, Noveve N, Ramraj T, Magasana V, Singh Y, Nsibande D, Goga AE. How ready are our health systems to implement prevention of mother to child transmission Option B+? South Afr J HIV Med 2015; 16:386. [PMID: 29568595 PMCID: PMC5843177 DOI: 10.4102/sajhivmed.v16i1.386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/06/2015] [Indexed: 12/02/2022] Open
Abstract
In January 2015, the South African National Department of Health released new consolidated guidelines for the prevention of mother to child transmission (PMTCT) of HIV, in line with the World Health Organization's (WHO) PMTCT Option B+. Implementing these guidelines should make it possible to eliminate mother to child transmission (MTCT) of HIV and improve long-term maternal and infant outcomes. The present article summarises the key recommendations of the 2015 guidelines and highlights current gaps that hinder optimal implementation; these include late antenatal booking (as a result of poor staff attitudes towards ‘early bookers’ and foreigners, unsuitable clinic hours, lack of transport to facilities, quota systems being applied to antenatal clients and clinic staff shortages); poor compliance with rapid HIV testing protocols; weak referral systems with inadequate follow-up; inadequate numbers of laboratory staff to handle HIV-related monitoring procedures and return of results to the correct facility; and inadequate supply chain management, leading to interrupted supplies of antiretroviral drugs. Additionally, recommendations are proposed on how to address these gaps. There is a need to evaluate the implementation of the 2015 guidelines and proactively communicate with ground-level implementers to identify operational bottlenecks, test solutions to these bottlenecks, and develop realistic implementation plans.
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Affiliation(s)
- Palesa Nkomo
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Natasha Davies
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, South Africa
| | - Gayle Sherman
- National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Paediatrics and Child Health, University of the Witwatersrand, South Africa
| | | | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Nobubelo K Ngandu
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Nobuntu Noveve
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Trisha Ramraj
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Vuyolwethu Magasana
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Yages Singh
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Duduzile Nsibande
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Ameena E Goga
- Health Systems Research Unit, South African Medical Research Council, South Africa.,Department of Paediatrics, University of Pretoria, South Africa
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