Prevention of mother-to-child transmission (PMTCT) implementation in rural community health centres in Mpumalanga province, South Africa

Abstract

This study explores organisational and individual provider influences on prevention of mother-to-child transmission (PMTCT) implementation at 12 community health centres (CHCs) in a rural South African setting. Clinic staff members (N = 103; females = 86%, nurse managers = 9.7%, nurses = 54.4%, lay health workers = 35.9%) were surveyed on PMTCT implementation acceptability and skills. The data were analysed using descriptive statistics comparing PMTCT protocol implementation achievements and clinic-level PMTCT indicators. Results indicate that staff were very positive about the frequency at which each element of the PMTCT protocol was achieved. Several areas where gaps in conformity to the PMTCT protocol were identified including delivery at the clinic, HIV retesting, provision of anti-retroviral treatment (ART) and six-week polymerase chain reaction (PCR) testing. It was unclear what organisational or individual characteristics contributed to this variation. Overall, providers’ perception of barriers to care and human resource capacity were unrelated to performance and fidelity of protocol implementation.

Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework

“…This review shows the promise and utility of EPIS to guide studies in various settings, topic areas, and geopolitical locations, and economically resourced regions. For example, our results demonstrate that EPIS has been used in high-, low-, and middle-income countries including Sweden [19], South Africa [20], and Mexico [21]. EPIS has also been used in other settings including public health [22], schools [23], and community health centers [24].…”

Barriers to the management of children under five exposed to human immunodeficiency virus in the rural areas in South Africa

“…The shortage of staff was identified in six articles included in this review (Habedi, Nolte & Temane 2016;Hanrahan & Williams 2017;Kaswa, Rupesinghe & Longo-Mbenza 2018;Peltzer et al 2016;Sithole & Khunou 2016;Skinner et al 2005). Shortage of staff in clinics was highlighted as one of the contributing barriers that hinder the management of HIV-exposed children.…”

“…At times when clinics are jam-packed, nurses would instruct some of the women to go back home and come back the following day because they were not coping with the workload (Habedi et al 2016;Hanrahan & Williams 2017). The PMTCT service was introduced to clinics without any additional staff to clinics that are already understaffed (Peltzer et al 2016;Skinner et al 2005), creating more challenges for the provision of PMTCT services. The shortage of staff including highly skilled trained staff such as nurseinitiated management of antiviral therapy (NIMART) in primary healthcare level in the rural areas robbed the majority of people, including women and their children, from receiving high-quality care.…”

“…The lack of knowledge was identified in five articles (Hanrahan & Williams 2017;Peltzer et al 2016;Sithole & Khunou 2016;Useh et al 2013;Wilford et al 2018). It is imperative that healthcare workers and women living with HIV remain knowledgeable and well updated with the PMTCT services, as this is the instrument to manage HIVexposed children.…”

Changing priorities in maternal and perinatal health in Gert Sibande District, South Africa

“…included community health centres in GSD, the rate of antiretroviral prescription immediately following diagnosis or entry into antenatal care ranged from 54% to 100%. [12] • In reaction to the non-attainment of MDGs 4 and 5, the Minister of Health insti tuted multiprofessional district clinical specialist teams (DCSTs) in all health districts in 2012. These teams are specifically tasked with initiating and overseeing quality improvement projects in maternal, newborn and child health using audit and observation tools.…”