Missed opportunities for participation in prevention of mother to child transmission programmes: Simplicity of nevirapine does not necessarily lead to optimal uptake, a qualitative study

Abstract

BackgroundThe objective of this study was to examine missed opportunities for participation in a prevention of mother-to-child transmission (PMTCT) programme in three sites in South Africa. A rapid anthropological assessment was used to collect in-depth data from 58 HIV-positive women who were enrolled in a larger cohort study to assess mother-to-child HIV transmission. Semi-structured interviews were conducted with the women in order to gain an understanding of their experiences of antenatal care and to identify missed opportunities for participation in PMTCT.Results15 women actually missed their nevirapine not because of stigma and ignorance but because of health systems failures. Six were not tested for HIV during antenatal care. Two were tested but did not receive their results. Seven were tested and received their results, but did not receive nevirapine. Health Systems failure for these programme leakages ranged from non-availability of counselors, supplies such as HIV test kits, consent forms, health staff giving the women incorrect instructions about when to take the tablet and health staff not supplying the women with the tablet to take.ConclusionHIV testing enables access to PMTCT interventions and should therefore be strengthened. The single dose nevirapine regimen is simple to implement but the all or nothing nature of the regimen may result in many missed opportunities. A short course dual or triple drug regimen could increase the effectiveness of PMTCT programmes.

The prevention of mother-to-child HIV transmission programme in Lilongwe, Malawi: why do so many women drop out

“…The clinics were selected to reflect different socio-economic profiles, rural-urban settings and size of patient load, factors that have been shown to affect women's PMTCT participation in Côte d'Ivoire and South Africa. 6,11,12 Site A, semi-urban, served over 174,000 people, provided antenatal care to 11.5% of pregnant women in Lilongwe and conducted approximately 3,000 deliveries annually. Site B, rural, served over 100,000 people and provided antenatal care to 6.5% of pregnant women in Lilongwe.…”

"Barriers to Uptake and Effective Integration of PMTCT into SRH Services in Selected Health Facilities in Nairobi County, Kenya"

“…Furthermore, implementing a PMTCT program as a part of routine healthcare may reduce stigma experienced by HIV infected women [5]. Integration of PMTCT with other healthcare services is a crucial component of the strategy to scale up PMTCT programs.…”

Guidelines in lower‐middle income countries

“…To achieve this, guideline developers will do well to study how evidence-based interventions may best be adapted for diverse LMIC settings (Tol et al, 2014). They should also remember that changes in guidelines or introduction of new guidelines take time to be accepted, thus healthcare practices may be slow to change (Nkonki et al, 2007).…”