PMTCT, and National's - Health Systems Trust

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Acknowledgements: This report would not have been possible without the co-operation and support of many individuals in the national and provincial Departments of Health. Provincial and District PMTCT co-ordinators facilitated access to the research sites and were co-operative and supportive of the evaluation. To the many health workers who allowed us to visit facilities and evaluate the programme, your dedication to PMTCT and willingness to share your experiences is deeply appreciated. Individuals from the national Department of Health, especially Dr Nono Simelela and Ms Sesupo Makakole-Nene, have been supportive and have provided valuable input at various stages of the research. We would also like to acknowledge the support received from the HST research sub-committee; namely Dr Zola Njongwe, Professor Craig Househam and Professor Eric Buch. The national PMTCT evaluation and research framework was developed by Dr David McCoy together with the National Department of Health. This framework made provision for two evaluations of the PMTCT programme, a national PMTCT cohort study as well as a number of sub-studies. Dr McCoy’s initiation and co-ordination of the PMTCT research studies has been key in ensuring the successful completion of these projects. The efforts of Candy Day and Halima Hoosen in the HealthLink programme in the final review and layout of this report are greatly appreciated. The infant testing component of section 6.3 (Infant Testing and Outcomes) was written by Dr Gayle Sherman, Mr Grant Napier and Dr Wendy Stevens of the Department of Molecular Medicine and Haematology, National Health Laboratory Service and University of the Witwatersrand. Contributions to the section 6.6.2 (Management of Information for PMTCT) were received from Louisa Williamson and Norah Stoops of the Health Information Systems Programme, University of the Western Cape. Abbreviations used in this publication: ATICC BFHI CHC CCLO DoH HIV HST HISP IEC ISDS MCWH / MCH MOU NAPWA NGO NVP PHC PMTCT PWA SAINT TAC UNICEF VCT WHO AIDS Training, Information and Counselling Centre Baby Friendly Hospital Initiative Community Health Centre Chief Community Liaison Officer Department of Health Human Immunodeficiency Virus Health Systems Trust Health Information Systems Programme Information, Education and Communication Initiative for Sub-District Support Maternal, Child (and Women’s) Health Midwife Obstetric Unit National Association of People With AIDS Non-Government Organisation Nevirapine Primary Health Care Prevention of Mother-to-Child Transmission People living With AIDS South African Intrapartum Nevirapine Trial Treatment Action Campaign United Nations Children’s Fund Voluntary Counselling and Testing World Health Organisation Provinces: EC FS GT KZN LP MP NC NW WC Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga Northern Cape North West Western Cape
CONTENTS 1. Executive summary 2. Introduction 3. Methodology and Design 4. Overview of Sites 5. Description of Routine Indicators 6. Key Findings and Recommendations 6.1 Antenatal Counselling and Testing 6.2 Dispensing of Nevirapine to Mothers and Infants 6.3 Infant Testing and Outcomes 6.4 Maternal and Infant Follow Up 6.5 Infant Feeding 6.6 Health Care Infrastructure 6.6.1 Human Resources 6.6.2 Management 6.7 Scaling up and Integrating PMTCT Initiatives Page Number 1 5 6 8 10 13 14 23 26 34 37 48 65
Page 3: An Evaluation of the Prevention of
Page 7 and 8: Dispensing of Nevirapine Nevirapine
Page 9 and 10: SCALING UP THE PMTCT PROGRAMME Ther
Page 11 and 12: AIM OF THE EVALUATION METHODOLOGY A
Page 13 and 14: OVERVIEW OF THE PMTCT PILOT SITES *
Page 15 and 16: DESCRIPTION OF ROUTINE PMTCT INDICA
Page 17 and 18: Nevirapine (NVP) dispensing rate to
Page 19 and 20: 6.1 Antenatal Counselling and Testi
Page 21 and 22: This rate has increased slightly si
Page 23 and 24: Group education followed by individ
Page 25 and 26: WHO 2 recommends that at least 50%
Page 27 and 28: APPENDIX 6.1: EXAMPLE OF A PEER COU
Page 29 and 30: Figure 6.2.1: Nevirapine dispensing
Page 31 and 32: 6.3 Infant Testing and Outcomes BAC
Page 33 and 34: DISCUSSION HIV Diagnosis in Infants
Page 35 and 36: Current Status of Infant Testing Cu
Page 37 and 38: Proposed Infant HIV Test Timelines
Page 39 and 40: 6.4 Maternal and Infant Follow Up I
Page 41 and 42: RECOMMENDATIONS FOR IMPROVING THE P
Page 43 and 44: KEY FINDINGS FROM THE EVALUATION In
Page 45 and 46: There is a need for caution when in
Page 47 and 48: Differences in provincial policies
Page 49 and 50: With only moderate support (one hom
Page 51 and 52: 4. Ensure on-going Support After De
Page 53 and 54: 6.6 Health Care Infrastructure This
Page 55 and 56:
Two options exist for the contracti
Page 57 and 58:
B. TRAINING OF HEALTH CARE WORKERS
Page 59 and 60:
Logistical and administrative suppo
Page 61 and 62:
6.6.2 Management A. NATIONAL MANAGE
Page 63 and 64:
C. MANAGEMENT OF CONSUMABLES AND SU
Page 65 and 66:
The changes made in data elements a
Page 67 and 68:
Data flow The PMTCT pilot programme
Page 69 and 70:
Appendix 6.6 MTCT REGISTER (to be k
Page 71 and 72:
The key to high coverage of the int
Page 73 and 74:
Health Care Infrastructure • Stre
Page 75 and 76:
Strategies to integrate PMTCT into
Page 77 and 78:
SUMMARY We need a fundamental rethi
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