Programme to improve implementation of the Prevention of Mother to Child Transmission of HIV in Gert Sibande district in Mpumalanga, South Africa: baseline report: Gert Sibande PMTCT programme implementation
: Research report- other PUBLICATION YEAR
: K.Peltzer, N.Phaswana-Mafuya, R.Ladzani, A.Davids, G.Mlambo, K.Phaweni, P.Dana, M.NdabulaKEYWORDS
, HIV/AIDS PREVENTION
, MPUMALANGA PROVINCE
, PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) PROGRAMMEDEPARTMENT
: Public Health, Societies and Belonging (HSC)
: HSRC Library: shelf number 6142
Download this report
If you would like to obtain a copy of this Research Output, please contact Hanlie Baudin at firstname.lastname@example.org.
Background: A baseline assessment of the PMTCT programme was conducted in the Gert Sibande district of Mpumalanga province in 2008-9 to gather information on the status of PMTCT programme implementation at all Gert Sibande health facilities prior to initiating programme strengthening activities. Identified gaps in the PMTCT programme were staff shortage, lack of guidelines, stock outs, no monitoring and evaluation system, lack of training and poor data collection methods. Interventions to address identified gaps are currently in progress. This report presents the baseline assessment results.
The assessment comprised
* Facility and
* Client assessments
Methods: A baseline rapid assessment was conducted by trained researchers in the formal health sector with pregnant mothers and mothers with infants between 3 months and 8 months of age.
(a) Interventions to strengthen PMTCT programme implementation
(b) Monitoring and evaluation support.
Few facilities had all the required national guidelines/protocols/policies on HIV management. More than half of facilities did not have all provincial guidelines/protocols/policies. 48 out of 75 facilities had the updated PMTCT guideline. Facilities generally had IEC materials. Seventy out of 75 facilities conducted on-site HIV testing and 68 had VCT services daily. Refusals on HIV testing by clients was reported by 62 facilities. Reasons stated by clients for refusal of testing were:
* fear of the outcome,
* client not ready for results,
* client scared of the test and
* some needed time to think.
Refusal of testing needs further investigation as the case registers does not distinguish clients who were tested during the previous pregnancy from new clients. Therefore, some clients might have refused because they have been tested before. All facilities had at least one PN responsible for HIV testing, except in Lekwa and Albert Luthuli. The need for training of staff on PMTCT/VCT was high in all sub-districts. Staff needed training on dual therapy. Most facilities generally had at least two lay counsellors, with a few exceptions, but there was no work schedule for lay counsellors. Lack of space made it difficult for some facilities to have a counselling room. More than half of facilities promoted family planning during VCT. Several facilities did not do PCR testing on site, and they did not have PCR testing kits.
Shortage of infant formula was reported by 64 facilities. A significant number of facilities did not have a follow-up system for infants born to HIV-positive mothers. Programme managers expressed concerns about staff shortage, untrained staff, space problem and lack of supervision. Women who opted to deliver their babies at home posed a challenge to health care facilities. Another challenge was women knew their HIV status did not disclose to their families. As a result of not disclosing, they mixed fed their infants. Clients manipulated ANC coding cards and some were reluctant to take the prophylaxis drug. A large number of PNs reported a need for community awareness on PMTCT issues.
M & E
With regards to the recording of client data on case registers, a number of concerns were observed. Data were recorded on loose A3 sheets that may be misplaced. Data recorded on case registers differed from that recorded on monthly summary sheets and DHIS data. Data elements recorded in case registers did not tally with those on DHIS. More elements were recorded in case registers. However, there were facilities that had good data recording as evidenced by concordant records in case registers, monthly summary sheets and DHIS. Poor data recording was attributed to staff shortage and heavy workload of PNs.
HIV knowledge and attitude
A high percentage of women were aware that HIV could be transmitted during pregnancy, delivery and through breast feeding. Disclosure of the HIV status was a challenge as 285 had not discussed their status with their partners. A concern that was reported by clients was ARV shortage at facilities. Some clients indicated that they were not given after testing for HIV. Lay counsellors proved to be valuable members of the health team as more clients received their HIV test results from lay counsellors than nurses.
Conclusion and recommendations: Findings of the rapid assessment reveal a need to strengthen PMTCT service delivery at Gert Sibande. Staff shortage compromises service delivery and the quality of service as the PNs are overwhelmed with a heavy workload. Bound case registers or electronic data recording would ease the problem of tallying data at the end of the month. The number of PNs needs to be increased as some facilities served a large population. A follow-up system for infants born to HIV mothers is crucial. Shortages of infant formula might lead to mixed feeding. Poor data might contribute to under stocking of infant formula. All clients who have been tested should receive their test results.
Related Research Outputs:
- Implementing a rural programme of Prevention of Mother-to-Child Transmission of HIV in Nkangala, South Africa: a baseline evaluation
- Prevention of mother to child transmission: a report of an assessment of a pilot programme in fifteen health facilities in Gauteng province
- Barriers to prevention of HIV transmission from mother to child (PMTCT) in a resource poor setting in the Eastern Cape, South Africa
- Obstacles in executing preventions plans for HIV birth infections
- Knowledge, attitudes and beliefs about male circumcision and HIV by traditional and medical providers of male circumcision and traditionally and medically circumcised men in Mpumalanga, South Africa
- Factors determining prenatal HIV testing for prevention of Mother to Child Transmission of HIV in Mpumalanga, South Africa
- Determinants of adherence to a single-dose nevirapine regimen for the Prevention of Mother-to-Child HIV Transmission in Gert Sibande district in South Africa
- Factors influencing pregnancy desires among HIV positive women in Gert Sibande district in Mpumalanga, South Africa
- Lay counsellor-based risk reduction intervention with HIV positive diagnosed patients at public HIV counselling and testing sites in Mpumalanga, South Africa
- Factors associated with short-course antiretroviral prophylaxis (dual therapy) adherence for PMTCT in Nkangala district, South Africa
- HIV sero-status disclosure and sexual behaviour among HIV positive patients who are on antiretroviral treatment (ART) in Mpumalanga, South Africa
- Know your HIV prevention response (KYR) analysis: report on the review of HIV prevention policies and programmes in the Mpumalanga province
- Promoting male involvement to improve PMTCT uptake and reduce antenatal HIV infection: a cluster randomized controlled trial protocol
- Report on PMTCT comprehensive community intervention package including male involvement, infant follow-up, peer support, partner violence and infant feeding in Nkangala district, Mpumalanga province
- PMTCT implementation in rural community health centres in Mpumalanga province, South Africa: final report
- Prevention of Mother to Child Transmission (PMTCT) implementation in rural community health centres in Mpumalanga Province, South Africa
- Prevention of mother-to-child transmission (PMTCT) implementation in rural community health centres in Mpumalanga province, South Africa
- Review of the HIV/AIDS policy, legislation, financing & implementation of programmes in Mozambique
- A review of HIV/AIDS policy, financing, legislation and programmes: South African case study: Draft
- The impact of HIV/AIDS on the health sector: national survey of health personnel, ambulatory and hospitalised patients and health facilities, 2002