The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

Violeta J Rodriguez,Richard P Lacabe,C Kyle Privette,K Marie Douglass,Karl Peltzer,Gladys Matseke,Audrey Mathebula,Shandir Ramlagan,Sibusiso Sifunda,Guillermo “Willy” Prado,Viviana Horigian,Stephen M Weiss,Deborah L Jones

doi:10.1080/17290376.2017.1375425

Abstract

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

Highlights

Global rates of mother-to-child transmission (MTCT) of HIV ranged from 20% to 45% (De Cock et al, 2000), though these rates were substantially reduced by Prevention of Mother-to-Child Transmission (PMTCT) strategies (De Cock et al, 2000; Johri & Ako-Arrey, 2011; Luo et al, 2007)
This study was conducted in collaboration with Protect Your Family (PYF), a PMTCT initiative being administered at Community Health Centers (CHCs) in Mpumalanga Province
This study addressed barriers and solutions to enhance implementation, uptake, and sustainment of the PMTCT protocol in rural South Africa (SA)

Summary

Introduction

Les obstacles culturels, des infrastructures, et socioeconomiques ont empechela mise en route du protocole de prevention de la transmission mere-enfant (PTME). Cette etude est orientee al’identification des difficultes et des solutions pour la mise en route, adaptation et soutenabilitedu protocole PTME dans des regions rurales d’Afrique du Sud. Dans ce but, l’etude a compris 45 interviews qualitatives, 12 group de discussion (n 1⁄4 75) et un workshop de deux journees (n 1⁄4 32 participants) developpes avec la participation des directeurs de district, des cliniciens responsables, personnel d’aide et des patients de 12 cliniques rurales. La livraison et l’acceptation du protocole PTME ont etee ́valuees en accord avec le CFIR (Consolidated Framework for Implementation Research) : 15 sujets associes aux difficultes et aux solutions sont apparus. In SA, national PMTCT programing resulted in a substantial reduction in MTCT rates in facility-based studies, though the impact of health system programing on these reductions is unclear (Goga et al, 2014)

Methods

Results

Discussion

Conclusion