scholarly journals Integrating the prevention of mother-to-child transmission of HIV after AIDS denialism in South Africa: Perspectives of experts and health care workers - A qualitative study

2020 ◽  
Author(s):  
Jean Claude MUTABAZI ◽  
Corie Gray ◽  
Lorrein Muhwava ◽  
Helen Trottier ◽  
Lisa Jayne Ware ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Health Services ◽  
Health System ◽  
Health Workers ◽  
Sub Saharan Africa ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Aids Denialism ◽  
Mother To Child

Abstract Background Integrating vertical programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of Prevention of Mother-to-Child Transmission programmes (PMTCT) in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing health services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. We explored the perspectives of both experts and frontline health workers (FHCWs) in South Africa on PMTCT integration into primary health care (PHC) in the context of post-AIDS denialism using a Complex Adaptive Systems framework. Methods We conducted a total of 20 in-depth semi-structured interviews; 10 with experts (PMTCT and health system experts, policymakers, researchers and activists) and 10 with FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis. Results Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programs into PHC following its initial rollout as a stand-alone program in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructure issues (such as lack of rooms, small spaces, etc.) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to protein-chain reaction (PCR) testing and immunisation. Conclusions Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT programmes in PHC, especially postpartum. Our results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.

scholarly journals A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Adebola Adedimeji ◽  
Nareen Abboud ◽  
Behailu Merdekios ◽  
Miriam Shiferaw
Keyword(s):  
Health System ◽  
Pregnant Women ◽  
Health Workers ◽  
Contextual Factors ◽  
Sub Saharan Africa ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Utilization Of Services ◽  
System Factors ◽  
Mother To Child

Objectives. Despite the availability of services to prevent mother-to-child transmission (PMTCT) of HIV, socio-cultural, health system and operational factors constrain many pregnant women from accessing services or returning for followup thereby increasing the risk of vertical transmission of HIV to newborns. We highlight and describe unique contextual factors contributing to low utilization of PMTCT services in Arba-Minch, Ethiopia. Methods. Qualitative research design was utilized to obtain data through focus group discussions and in-depth interviews with antenatal clinic attendees, health workers health facilities in the study area. Results. Awareness of PMTCT services and knowledge of its benefits was nearly universal, although socioeconomic, cultural and health system factors, including stigma and desire to prevent knowledge of serostatus, impede access to and utilization of services. Health system factors—lack of appropriate followup mechanisms, inadequate access to ARV drugs and poorly equipped manpower also contribute to low utilization of services. Conclusion. Reducing mother-to-child transmission of HIV in sub-Saharan Africa will be more effective when unique contextual factors are identified and addressed. Effectiveness of PMTCT interventions rests on a well functioning health system that recognize the importance of social, economic, cultural contexts that HIV positive pregnant women live in.

scholarly journals Prevention of mother to child transmission lay counsellors: Are they adequately trained?

Curationis ◽  
2012 ◽  
Vol 35 (1) ◽  
Author(s):  
Catherine H. Thurling ◽  
Candice Harris
Keyword(s):  
South Africa ◽  
Health Care ◽  
Approaches To Learning ◽  
Total Sample ◽  
Working Environment ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Structured Interviews ◽  
Two Phase ◽  
Mother To Child

South Africa’s high prevalence of human immunodeficiency virus (HIV) infected women requires a comprehensive health care approach to pregnancy because of the added risk of their HIV status. As a result of the shortage of health care workers in South Africa, lay counsellors play important roles in the prevention of mother to child transmission of HIV (PMTCT).There is no standardization of training of lay counsellors in South Africa, and training varies in length depending on the training organisation.The study aimed to investigate the training of lay counsellors by analysing their training curricula and interviewing lay counsellors about their perceptions of their training.A two phase research method was applied. Phase one documented an analysis of the training curricula. Phase two was semi-structured interviews with the participants. Purposive sampling was undertaken for this study. The total sample size was 13 people, with a final sample of 9 participants, determined at the point of data saturation.The research was qualitative, descriptive and contextual in design. The curricula analysed had different styles of delivery, and the approaches to learning and courses varied, resulting in inconsistent training outcomes. A need for supervision and mentorship in the working environment was also noted.The training of lay counsellors needs to be adapted to meet the extended roles that they are playing in PMTCT. The standardization of training programmes, and the incorporation of a system of mentorship in the work environment, would ensure that the lay counsellors are adequately prepared for their role in PMTCT.

scholarly journals Integrating gestational diabetes and type 2 diabetes care into primary health care: Lessons from prevention of mother-to-child transmission of HIV in South Africa - A mixed methods study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245229
Author(s):  
Jean Claude Mutabazi ◽  
Pascal Roland Enok Bonong ◽  
Helen Trottier ◽  
Lisa Jayne Ware ◽  
Shane A. Norris ◽  
...  
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Mixed Methods ◽  
Gestational Diabetes ◽  
Western Cape ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Mother To Child

Background Implementation of the programmes for the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) into antenatal care over the last three decades could inform implementation of interventions for other health challenges such as gestational diabetes mellitus (GDM). This study assessed PMTCT outcomes, and how GDM screening, care, and type 2 diabetes (T2DM) prevention were integrated into PMTCT in Western Cape (WC), South Africa. Methods A convergent mixed methods and triangulation design were used. Content and thematic analysis of PMTCT-related policy documents and of 30 semi-structured interviews with HIV/PMTCT experts, health care workers and women under PMTC diagnosed with GDM complement quantitative longitudinal analysis of PMTCT implementation indicators across the WC for 2012–2017. Results Provincial PMTCT and Post Natal Care (PNC) documents emphasized the importance of PMTCT, but GDM screening and T2DM prevention were not covered. Data on women with both HIV and GDM were not available and GDM screening was not integrated into PMTCT. Women who attended HIV counselling and testing annually increased at 17.8% (95% CI: 12.9% - 22.0%), while women who delivered under PMTCT increased at 3.1% (95% CI: 0.6% - 5.9%) annually in the WC. All 30 respondents favour integrating GDM screening and T2DM prevention initiatives into PMTCT. Conclusion PMTCT programmes have not yet integrated GDM care. However, Western Cape PMTCT integration experience suggests that antenatal GDM screening and post-partum initiatives for preventing or delaying T2DM can be successfully integrated into PMTCT and primary care.

Sign in / Sign up

Export Citation Format

Share Document