Investigating the quality of HIV rapid testing practices in public antenatal health care facilities, South Africa

Abstract

Monitoring HIV prevalence using antenatal HIV sentinel surveillance is important for efficient epidemic tracking, programme planning and resource allocation. HIV sentinel surveillance usually employs unlinked anonymous HIV testing which raises ethical, epidemiological and public health challenges in the current era of universal test and treat. The World Health Organization (WHO) recommends that countries should consider using routine prevention of mother-to-child transmission of HIV (PMTCT) data for surveillance. We audited antenatal care clinics to assess the quality of HIV rapid testing practices as the first step to assess whether South Africa is ready to utilize PMTCT programme data for antenatal HIV surveillance. In 2017, we conducted a cross-sectional survey in 360 randomly sampled antenatal care clinics using the adapted WHO Stepwise-Process-for-Improving-the-Quality-of-HIV-Rapid-Testing (SPI-RT) checklist. We calculated median percentage scores within a domain (domain-specific median score), and across all domains (overall median percentage scores). The latter was used to classify sites according to five implementation levels; (from 0:<40% to 4: 90% or higher). Of 346 (96.1%) facilities assessed, an overall median percentage score of 62.1% (inter-quartile range (IQR): 50.8–71.9%) was obtained. The lowest domain-specific median percentage scores were obtained under training/certification (35% IQR: 10.0–50.0%) and external quality assurance (12.5% IQR: 0.0–50.0%), respectively. The majority (89%) of sites had an overall median score at level 2 or below; of these, 37% required improvement in specific areas and 6.4% in all areas. Facilities in districts implementing the HIV Rapid Test Quality Improvement Initiative and supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) had significantly higher median overall scores (65.6% IQR: 53.9–74.2%) (P-value from rank sum test: <0.001) compared with non–PEPFAR–supported facilities (56.6% IQR:47.7–66.0%). We found sub-optimal implementation of HIV rapid testing practices. We recommend the expansion of the PEPFAR-funded Rapid Test Continuous Quality Improvement (RTCQI) support to all antenatal care testing sites.

Factors affecting antenatal care attendance in Soweto, Johannesburg: The three-delay model

“…In South Africa, the HIV Prevention-of-Mother-to-Child (PMTC) programme has managed to detect and treat maternal HIV infections to ensure that unborn babies are not exposed to HIV. 51 However, the downside of PMTC programme is that it exposes women to the psychological burden of dealing with an HIV status while pregnant. 51 , 52 , 53 , 54 Fear of testing for HIV during pregnancy was also observed in a study conducted by Brittain Myer et al 55 in Cape Town, who found that pregnant women are afraid of taking Antiretrovirals (ARVs) because they will be forced to disclose their HIV status to their partners.…”

“… 51 However, the downside of PMTC programme is that it exposes women to the psychological burden of dealing with an HIV status while pregnant. 51 , 52 , 53 , 54 Fear of testing for HIV during pregnancy was also observed in a study conducted by Brittain Myer et al 55 in Cape Town, who found that pregnant women are afraid of taking Antiretrovirals (ARVs) because they will be forced to disclose their HIV status to their partners. This has led to cases of gender-based violence where pregnant women are blamed and beaten up for bringing HIV into the relationship.…”

Exploring the validity of routine individuated service data for antenatal HIV surveillance in the Western Cape

“…To facilitate this transition in surveillance strategy, evaluations of routine data are required. A 2020 assessment of the national prevention-of-mother-to child programme concluded that South Africa was close to achieving the transition to routine data surveillance in relation to HIV testing, but that further evaluation of data completeness and accuracy was required (11,12). While these studies look speci cally at the validity of routine HIV testing data in comparison to laboratory-based HIV testing data from surveys, it should be emphasised that HIV patient management in South Africa is based on routine HIV point-of-care testing results.…”