Contributory factors to partial implementation of prevention of mother to child transmission policy in South Africa.

backgroundSouth Africa (SA) is amongst the countries that adopted the Global plan towards the elimination of new HIV infections amongst children and keeping their mothers alive, launched in June 2011 as well the global HIV strategies of the Sustainable Development Goal (SDG) 3.3 target of ending the HIV epidemic by 2030, including the strategy for measuring impact and progress made in the prevention of mother-to-child transmission (PMTCT), now called Vertical Transmission Prevention (VTP) of HIV and communicable infections. All targets outlined in the Global Plan for elimination of Mother to child transmission (eMTCT) have almost been reached by the country, showing potential to achieve eMTCT by 2030.Successes are attributed to PMTCT policy of SA being amongst the best in the world. However, despite the well-established PMTCT programme, PMTCT implementation gaps still exist. This study ascertained identified gaps as follows: Of 163 accounted for pregnant women participants, 82(53.0%) booked before 20 weeks of gestational dates for their first ANC booking as advocated for by the PMTCT policy,81 were late bookers who had potential for not having their viral load suppressed, with high risk of MTCT.15 were missing and unaccounted for. 91 of 101 (89.11%) pregnant HIV positive women commenced ART on the day of their diagnosis, during their first ANC attendance. 67 were known HIV positive pregnant women already on ART who came for their first booking The remaining 10 pregnant HIV positive women did not begin ART early in their pregnancy and have the potential of not being virally suppressed Viral load was poorly monitored-25.0% had no viral load testing done at their first ANC booking,47% were tested at delivery and 49.0% tested at 6-months after delivery.150 of 164 HIV positive women who were eligible for a routine six-to-twelve-week post-partum were missed opportunities.100 of 178 (56.2%) HIV exposed babies were given NVP and AZT prophylaxis Baby Polymerase Chain Reaction(PCR) testing:Of 178 HIV exposed babies, 122 (69%) were tested at birth, 113 of 178(63%) were tested at 10 weeks There was 6 (3.5%) of babies who seroconverted after 103 of 178 (58%) were tested. at 6-months. THE AIM OF THE STUDY: To address identified gaps, inform future policy formulation and improve PMTCT practices, ascertaining the country to achieve eMTCT by 2030.

objectiveTo conduct file audit at selected facilities to assess and verify the existence of implementation gaps.

methodA quantitative, cross-sectional survey of routinely collected clinic data. The survey was chosen to conduct clinical records audits of mother and baby pairs client records from 18 facilities rendering PMTCT services, representative of the rural and urban areas in all the nine provinces of SA Five (5) Mother and baby pairs client records, each containing specific tools used for measuring PMTCT programme progress amounting to 3 160 files were randomly selected. The investigator developed a checklist from all existing approved PMTCT M&E sampled tools, condensed into one document and used to collect data from all sampled client's records. STATA software was used for data analysis.

resultsThe audit revealed several factors, related to non-compliance to interventions of the PMTCT policy, poor integration of mother and baby services; poor client management and poor documentation practices. DISCUSSION: The results indicate that, despite, the well-established PMTCT programme in place in the country, implementation gaps still exist as a result of non-compliance to the PMTCT policy. There is an urgent need to prioritise and support implementers to fully implement the PMTCT policy.

conclusionThe study ascertained PMTCT policy implementation gaps that still exist as a result of non- compliance to interventions advocated for by the PMTCT policy Poor adherence and non -adherence to PMTCT policy may have an impact on the ultimate objectives of the whole program and derail the country to achieve eMTCT by 2030.