Asessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape Local Service Area

Abstract

Setting:

The Kouga Local Service Area (LSA) located in the area surrounding the Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape.

Methods:

An assessment was conducted in 2007 before implementing technical support for PMTCT programme strengthening including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities and the District Health Information System (DHIS) data was reviewed.

Results:

Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation.

Conclusions:

Reducing missed opportunities for PMTCT requires formal health sector strengthening, intersectoral liaison and enhancing community support. Priority areas for strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.