Evaluation of the new Option B+ Prevention of Mother to Child Transmission (PMTCT) Program for HIV Infected Women at Hospital Facilities: Case Study at the Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
Abstract
Background: South Africa’s National Department of Health has adopted World Health Organization’s (WHO) 2013 consolidated guidelines on the use of ARVs for treatment and prevention of HIV infection (1). The guidelines include changes for prevention of mother to child transmission (PMTCT) through Option B+. Option B+ aims to reduce the HIV prevalence rate amongst these women by placing them on ART for life, no matter their CD4 count (2). As a result, in January 2015, these guidelines were implemented for the PMTCT programme at RMMCH. Little is known about the impact of these new guidelines on the work of healthcare professionals in state hospitals. Most importantly, no research has focused on how these changes have affected adherence for the patients.
Purpose: The purpose of this research project is (a) to explore the impact of the Option B+ PMTCT programme on the work of healthcare professionals, and (b) to understand pregnant HIV-positive women views and experiences with ART for life, as a way to better manage the Option B+ PMTCT programme.
Methods: A qualitative study design is used with a phenomenological approach. The methodology uses demographic questionnaires and semi-structured interviews with healthcare professionals and patients. The study is situated in Johannesburg, South Africa.
Findings: The findings demonstrate that work has changed and become difficult to manage for all healthcare professionals because of (a) the need for strengthening indicators for tracking to decrease loss to follow-up (LTFU); (b) inconsistency in delivery of counseling and support services and the need for communication across clinical departments; and (c) the lack of compassion and understanding by service providers. The difficult healthcare environment has affected overall views and experiences of pregnant HIV-positive women going on ART for life. All 55 patient participants responded that they chose to take the fixed-dose combination (FDC) for life to protect the health of the baby and felt ART for life can be stopped after giving birth.
Conclusion: Implications for future research include the need to address changes within the healthcare system at both clinical and management levels. It is crucial to incorporate the perspective of patients in policy implementation; uptake and adherence are key indicators in informing whether the Option B+ PMTCT programme is being adapted into state hospitals effectively (4). There needs to be extensive research on how to strengthen indicators for long term scalability and sustainability of the programme. Future evaluations need to address, will interdisciplinary collaboration within hospitals improve the management and understanding of Option B+?
Full length article: http://hdl.handle.net/11375/18348
References
1. UNICEF. Options B and B+: Key Considerations for Countries to Implement an Equity- Focused Approach. Geneva, Switzerland: UNICEF; 2012.
2. World Health Organization (WHO). Implementation of Option B+ for prevention of mother-to- child transmission of HIV: the Malawi experience. Republic of Congo: WHO; 2014.
3. UNICEF. A Business case for Options B and B+ to eliminate mother to child transmission of HIV by 2015. New York: UNICEF; 2012.
4. McIntyre DI, Thiede M, Birch S. Access as a policy-relevant concept in low-and- middle income countries. Health Econ Policy Law, 2009; 4(02):179-193.
