Interim Findings on the National PMTCT Pilot Sites: Lessons and Recommendations - February 2002

BACKGROUND TO THE REPORT: This report primarily describes the process, progress and extent of service implementation in the 18 pilot PMTCT sites, so as to help improve the effectiveness and efficiency of PMTCT services and inform any planned expansion of the programme. Data and information is based on discussions and interviews with managers, coordinators and clinicians; site visits; routine statistics; document reviews; and attendance of national PMTCT steering committee meetings.

The report does not provide data on the impact of the programme on HIV transmission or health outcomes, mainly because the programme is still too young for this. However, Section 6 presents and discusses what is currently known about mother-to-child transmission, including the proven efficacy of NVP. It also discusses the effects of different forms of infant feeding on HIV transmission and child health, and raises a number of important policy issues.

OVERVIEW OF THE PILOT PROGRAMME

193 health facilities (hospitals, midwife obstetric units, community health centers and clinics) are currently part of the national PMTCT pilot programme. They cover approximately 6,090 ante-natal bookings per month, which translates to about 9% of the total number of country-wide bookings.

The full figure for access to PMTCT in South Africa is considerably more. Some provinces have already begun to expand their services, and together with a number of clinical research sites, the full proportion of pregnant women in this country with access to HIV counselling, testing and NVP may be as high as 15%.

The rate at which pregnant women agree to be tested for HIV is currently 51% in the national PMTCT sites. This translates to about 3,133 pregnant women being tested per month, which is a very positive achievement. The testing uptake rate varies tremendously between provinces and sites (ranging from 17% to 90%), and the reasons for these differences are described in this report. Overall, the HIV testing uptake rate is likely to improve over time.

Of the women agreeing to HIV testing, about 30% are HIV positive. On the basis of these VCT uptake and sero-positivity rates, it is estimated that 6,343 HIV positive pregnant women have been identified in the national PMTCT sites. However, the recorded number of HIV positive women who have delivered with the administration of NVP to both mother and baby is 1,932. Some of the reasons for this large difference in numbers are:

* Because HIV testing usually occurs several months before delivery, at any given point in time, the cumulative number of identified HIV positive pregnant women will be more than the cumulative number of deliveries (especially at the beginning of a programme).
* Women accessing the PMTCT service ante-natally may deliver elsewhere.
* An under-recording of statistics in the labour wards.

PROGRESS WITH IMPLEMENTATION AND LESSONS LEARNT

The experience with implementation has varied considerably, with some provinces and sites doing well, whilst others have struggled. Many of the difficulties and constraints to full and effective implementation were identified as being systemic in nature, and relate to the poor functioning of the health care system in general (as opposed to the functioning of the PMTCT programme specifically).

At the core of the differences between provinces and sites are the large inequities in health care infra-structure within the country.

contd...

[For the full report, click on the link to the department's website on the top right-hand corner of this page]