Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013–2016

Abstract

Objective To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. Methods We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 2013-2016. Two survey rounds were conducted (2013-2015 and 2015-2016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round. Findings In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds. Conclusion Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals.

Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: A mixed methods multi-country study

“…For example, providers in Ifakara reported not allowing other specified people to collect ART supplies for their client, and facilities in Ifakara and uMkhanyakude also reported only providing a onemonth supply of drugs, despite the national policy for multi-month scripting. Other studies have highlighted that flexible HIV care policies can lead to varied implementation (Ambia et al, 2017;Jones et al, 2019).…”

Approaches to transitioning women into and out of prevention of mother‐to‐child transmission of HIV services for continued ART: a systematic review

“…Other barriers and facilitators of transition included characteristics of the health facility and system. Although the WHO recommends interventions using case managers or navigators to enhance linkage between services, a review of PMTCT policy and policy implementation in Malawi, South Africa and Tanzania, found that most Malawian, but few other facilities implemented this and none had explicit guidance in their national policy [11]. There is a clear need for guidelines on the transition process and greater understanding by health providers and clients.…”

The Intergenerational Impact of a Slow Pandemic: HIV and Children

“…This reduction in transmission risk was first realized in the prevention of mother to child transmission (PMTCT). Initially pregnant women were treated with a single drug to prevent vertical transmission, (Newell, 2001) then with a combination of drugs during pregnancy for improved protection of infants (Mofenson, 2008), and finally in "B+" programs, where women were treated before during and after pregnancy to protect their own health and to prevent vertical transmission (Jones et al, 2019). Additional reductions in HIV incidence in young women where HIV programs have succeeded in reducing horizontal transmission have also contributed to the reduced acquisition of HIV in children.…”