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How ready are our health systems to implement prevention of mother to child transmission Option B+?

Palesa Nkomo, Natasha Davies, Gayle Sherman, Sanjana Bhardwaj, Vundli Ramokolo, Nobubelo K. Ngandu, Nobuntu Noveve, Trisha Ramraj, Vuyolwethu Magasana, Yages Singh, Duduzile Nsibande, Ameena E. Goga
Southern African Journal of HIV Medicine | Vol 16, No 1 | a386 | DOI: https://doi.org/10.4102/sajhivmed.v16i1.386 | © 2015 Palesa Nkomo, Natasha Davies, Gayle Sherman, Sanjana Bhardwaj, Vundli Ramokolo, Nobubelo K. Ngandu, Nobuntu Noveve, Trisha Ramraj, Vuyolwethu Magasana, Yages Singh, Duduzile Nsibande, Ameena E. Goga | This work is licensed under CC Attribution 4.0
Submitted: 15 April 2015 | Published: 07 October 2015

About the author(s)

Palesa Nkomo, Health Systems Research Unit, South African Medical Research Council, South Africa
Natasha Davies, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, South Africa
Gayle Sherman, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Paediatrics and Child Health, University of the Witwatersrand, South Africa
Sanjana Bhardwaj, The United Nations Children’s Fund, Pretoria, South Africa
Vundli Ramokolo, Health Systems Research Unit, South African Medical Research Council, South Africa
Nobubelo K. Ngandu, Health Systems Research Unit, South African Medical Research Council, South Africa
Nobuntu Noveve, Health Systems Research Unit, South African Medical Research Council, South Africa
Trisha Ramraj, Health Systems Research Unit, South African Medical Research Council, South Africa
Vuyolwethu Magasana, Health Systems Research Unit, South African Medical Research Council, South Africa
Yages Singh, Health Systems Research Unit, South African Medical Research Council, South Africa
Duduzile Nsibande, Health Systems Research Unit, South African Medical Research Council, South Africa
Ameena E. Goga, Health Systems Research Unit, South African Medical Research Council, South Africa; Department of Paediatrics, University of Pretoria, South Africa


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Abstract

In January 2015, the South African National Department of Health released new consolidated guidelines for the prevention of mother to child transmission (PMTCT) of HIV, in line with the World Health Organization’s (WHO) PMTCT Option B+. Implementing these guidelines should make it possible to eliminate mother to child transmission (MTCT) of HIV and improve long-term maternal and infant outcomes. The present article summarises the key recommendations of the 2015 guidelines and highlights current gaps that hinder optimal implementation; these include late antenatal booking (as a result of poor staff attitudes towards ‘early bookers’ and foreigners, unsuitable clinic hours, lack of transport to facilities, quota systems being applied to antenatal clients and clinic staff shortages); poor compliance with rapid HIV testing protocols; weak referral systems with inadequate follow-up; inadequate numbers of laboratory staff to handle HIV-related monitoring procedures and return of results to the correct facility; and inadequate supply chain management, leading to interrupted supplies of antiretroviral drugs. Additionally, recommendations are proposed on how to address these gaps. There is a need to evaluate the implementation of the 2015 guidelines and proactively communicate with ground-level implementers to identify operational bottlenecks, test solutions to these bottlenecks, and develop realistic implementation plans.

Keywords

PMTCT; Health systems; PMTCT guidelines; antenatal bookin; Option B+

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