The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

Violeta J. Rodriguez, Richard P. LaCabe, C. Kyle Privette, K. Marie Douglass, Karl Peltzer, Gladys Matseke, Audrey Mathebula, Shandir Ramlagan, Sibusiso Sifunda, Guillermo J Prado, Viviana Horigian, Stephen M Weiss, Deborah Jones

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff-patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

Original languageEnglish (US)
Pages (from-to)38-52
Number of pages15
JournalSAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance
Volume14
Issue number1
DOIs
StatePublished - Dec 1 2017

Fingerprint

sustainability
Mothers
HIV
staff
research implementation
South Africa
rural area
Transportation of Patients
Research
Forms and Records Control
Prenatal Care
United Nations
Health Facilities
Disclosure
Patient Education
Focus Groups
qualitative interview
group discussion
scheduling
shortage

Keywords

  • Afrique du Sud
  • HIV
  • implementation research
  • implementation science
  • PMTCT
  • prévention de la transmission mère-enfant (PMTE)
  • South Africa
  • VIH et le SIDA

ASJC Scopus subject areas

  • Health(social science)
  • Immunology and Allergy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

The Achilles' heel of prevention to mother-to-child transmission of HIV : Protocol implementation, uptake, and sustainability. / Rodriguez, Violeta J.; LaCabe, Richard P.; Privette, C. Kyle; Douglass, K. Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo J; Horigian, Viviana; Weiss, Stephen M; Jones, Deborah.

In: SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance, Vol. 14, No. 1, 01.12.2017, p. 38-52.

Research output: Contribution to journalArticle

Rodriguez, Violeta J. ; LaCabe, Richard P. ; Privette, C. Kyle ; Douglass, K. Marie ; Peltzer, Karl ; Matseke, Gladys ; Mathebula, Audrey ; Ramlagan, Shandir ; Sifunda, Sibusiso ; Prado, Guillermo J ; Horigian, Viviana ; Weiss, Stephen M ; Jones, Deborah. / The Achilles' heel of prevention to mother-to-child transmission of HIV : Protocol implementation, uptake, and sustainability. In: SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance. 2017 ; Vol. 14, No. 1. pp. 38-52.
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