MPH, Maternal and Child Health, Faculty of Health Sciences, University of the Witwatersrand / Due to the high prevalence of HIV in South Africa, all pregnant women are offered an
HIV test as part of the package of services offered during ante natal care (ANC). All
women who present to an ANC clinic for the first time for that given pregnancy are given
group talks about HIV and the availability of services to protect their children from HIV
through Prevention of Mother to Child Transmission (PMTCT) services. Following these
group discussions, all the women are then counselled on a one on one basis and are
offered an HIV test. Women who decide not to take the test can opt out of testing at this
stage, those who do go ahead and test are also offered post test counselling after which
their test result is given to them. All HIV tests are conducted using rapid HIV test kits
which make results known within 15 minutes, the results are given to the women on the
same day of testing.
Women whose CD4 count is below the antiretroviral treatment(ART) initiation
threshold† are fast tracked onto ART , those whose CD4 is above the threshold should
then be referred to other services which can help them maintain their health.1 These
services are part of the Comprehensive Care, Management and Treatment (CCMT)
approach. They include: CD4 count monitoring; treatment for opportunist infections;
social workers, and support groups for psychosocial support.2 For purposes of this study,
these services are collectively referred to as Wellness services. Thus PMTCT should
serve as a gateway to either ART or Wellness services.
This study therefore sought to describe the linkages between PMTCT, ART and Wellness
by reviewing service utilisation levels and referral systems at sampled health facilities in
Soweto.
Data for this study were collected via a cross sectional record review of PMTCT registers
and an ART initiation register at sampled health facilities. PMTCT registers were
reviewed for the period January to March 2008 to determine what service had been given
to pregnant women who accessed PMTCT services for the first time during that period
† In his speech on World AIDS Day (December 1st 2009) President Jacob Zuma announced that CD4 count
threshold for treatment initiation will be raised from 200 to 350 as of April 2010.
0707048E 2
and which follow on services they had been referred to. ART registers were reviewed for
the period January to August 2008 to determine which of the pregnant women who had
been referred to ART from the PMTCT service points at the sampled clinics accessed the
service. Key informant interviews were also conducted with staff at PMTCT, ANC, ART
and voluntary counselling and testing (VCT) service points at the sampled facilities.
Descriptive statistics were run using SPSS version 17.0, comparisons were done using
OpenEpi and key informant interview data were thematically analysed using Atlas TI
version 5.2.0.
Records at the PMTCT clinics showed that of the 1350 women who attended ANC
clinics at the sampled facilities between January and March 2008, all but one agreed to
test for HIV. Twenty-nice percent (388) tested positive for HIV. Of these 388 HIV
positive women, 20% (77 women) had CD4 counts below 200 and were therefore eligible
for initiation of ART. Review of records at the ART clinic showed that only 23% (n =
18, N = 77) of all ART eligible women had accessed the service. Review of the PMTCT
register also showed that a significant proportion, 37% (n = 144, N =388), of women who
tested HIV positive did not return to the clinics for their CD4 count results. These
women therefore missed opportunities to access other follow on services to which they
could have been referred and possibly ART as 31% (24 women) of these women were
also eligible for ART.
Review of records at Wellness services was not possible as no indications were made in
the PMTCT registers of follow on services other than ART to which HIV positive women
were referred.
Thus the greater majority of women who were eligible for ART (77% of the 77 eligible
women) did not access ART which they required to help them maintain their physical
wellbeing. These women missed the opportunity to access holistic health care services, it
is not known if they accessed ART services at other health facilities. Without the
required antiretroviral therapy, it is highly likely that their women’s health status
deteriorated such that they faced higher chances of morbidity and ultimately mortality.
0707048E 3
The review of records at both PMTCT and ART service points showed poor data
management systems as referrals from PMTCT to ART were not always documented
against client names in the PMTCT registers. Communication systems between the
service points were also found to be poorly structured as there were no systematic
feedback mechanisms on clients referred and seen. Linkages to Wellness services were
even more poorly structured as no referrals to services which fall under Wellness were
documented in the PMTCT registers.
Key informants interviewed suggested several possible reasons why PMTCT and ART
services were not being fully utilised as was evidenced by the of 37% of women who
were not retained in care as they did not return for CD4 results and the low ART
utilisation rate of 23%. Possible reasons suggestions were: ignorance of the need to
access ANC services, preference for traditional medicine, fear of stigmatisation within
their communities and poor staff attitudes towards patients.
The key informants also suggested measures they thought could improve utilisation, these
include hire of more staff, improved staff wages, improved interdepartmental
communication and a bottom up approach to service improvement. A suggestion was
also made to include PMTCT messaging in general HIV/AIDS information education
communication material so as to raise awareness of the availability of PMTCT
interventions.
Although there were linkages between PMTCT, ART and Wellness services, these
linkages were poorly developed and drop out from services was high. Efforts to follow
up on patients or to retain them in care were not well developed as the data management
systems employed by the service points were not consistently used nor did they facilitate
patient monitoring and follow-up. Furthermore, the structural and managerial separation
of the ART service point from PMTCT as well as the lack of standard protocols for
referral to Wellness introduced barriers to service utilisation for women who required
these services.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/9050 |
| Date | 18 February 2011 |
| Creators | Ching'andu, Annette Mulenga |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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