title: Prevention of mother to child transmission of HIV (PMTCT) programme in KwaZulu-Natal, South Africa: an evaluation of PMTCT implementation and integration into routine maternal, child and women's health services.
abstract: OBJECTIVE
  To evaluate prevention of mother to child transmission of HIV (PMTCT) implementation and integration of PMTCT with routine maternal and child health services in two districts of KwaZulu-Natal; to report PMTCT coverage, to compare recorded and reported information, and to describe responsibilities of nurses and lay counsellors.
  
  
  METHODS
  Interviews were conducted with mothers in post-natal wards (PNW) and immunisation clinics; antenatal and child health records were reviewed. Interviews were conducted with nurses and lay counsellors in primary health care clinics.
  
  
  RESULTS
  Eight hundred and eighty-two interviews were conducted with mothers: 398 in PNWs and 484 immunisation clinics. During their recent pregnancy, 98.6% women attended antenatal care (ANC); 60.8% attended their first ANC in the third trimester, and 97.3% were tested for HIV. Of 312 mothers reporting themselves HIV positive during ANC, 91.3% received nevirapine, 78.2% had a CD4 count carried out, and 33.1% had a CD4 result recorded. In the immunisation clinic, 47.6% HIV-exposed babies had a PCR test, and 47.0% received co-trimoxazole. Of HIV-positive mothers, 42.1% received follow-up care, mainly from lay counsellors. In 12/26 clinics, there was a dedicated PMTCT nurse, PCR testing was not offered in 14/26 clinics, and co-trimoxazole was unavailable in 13/26 immunisation clinics. Nurses and lay counsellors disagreed about their roles and responsibilities, particularly in the post-natal period.
  
  
  CONCLUSIONS
  There is high coverage of PMTCT interventions during pregnancy and delivery, but follow-up of mothers and infants is poor. Poor integration of PMTCT services into routine care, lack of clarity about health worker roles and poor record keeping create barriers to accessing services post-delivery.
authors.affiliation: Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa. horwoodc@ukzn.ac.za
authors.forename: C
authors.initials: C
authors.lastname: Horwood
authors.forename: L
authors.initials: L
authors.lastname: Haskins
authors.forename: K
authors.initials: K
authors.lastname: Vermaak
authors.forename: S
authors.initials: S
authors.lastname: Phakathi
authors.forename: R
authors.initials: R
authors.lastname: Subbaye
authors.forename: T
authors.initials: T
authors.lastname: Doherty
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008430:Maternal-Child Health Centers / Q000458:organization & administration* / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology; D015397:Program Evaluation; D013019:South Africa; D014932:Women's Health Services / Q000592:standards
chemical_list: D019380:Anti-HIV Agents