Rispel L C, Peltzer K, Phaswana-Mafuya N, Metcalf C A, Treger L
Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg.
S Afr Med J. 2009 Mar;99(3):174-9.
Prevention of new HIV infections is a critical imperative for South Africa; the prevention of mother-to-child transmission (PMTCT) is one of the most efficacious HIV prevention interventions.
Assessment of a PMTCT programme to determine missed opportunities.
The Kouga local service area (LSA), bordering Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape.
An assessment was conducted in 2007 before implementing technical support for strengthening the PMTCT programme, including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities, and the District Health Information System (DHIS) data were reviewed.
Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation.
Reducing missed opportunities for PMTCT requires strengthening of the formal health sector, intersectoral liaison, and greater community support. Priority areas that require strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.
预防新的艾滋病毒感染对南非至关重要；预防母婴传播（PMTCT）是最有效的艾滋病毒预防干预措施之一。
评估一项预防母婴传播计划以确定错失的机会。
夸加地方服务区（LSA），与东开普省纳尔逊·曼德拉湾市（伊丽莎白港）接壤。
2007年在为加强预防母婴传播计划提供技术支持之前进行了一项评估，包括：采访20名预防母婴传播管理人员、4名产科工作人员和27名其他卫生工作者，了解服务提供、管理、基础设施、人力资源和卫生信息系统情况；采访296名产前诊所使用者，了解他们对服务的看法；采访70名艾滋病毒呈阳性的妇女，了解她们的艾滋病毒知识、婴儿喂养、应对方式、支持情况和对服务的看法；采访8名社区组织代表和101名传统卫生从业者（THP）。在对卫生设施进行实地考察期间进行了观察，并审查了地区卫生信息系统（DHIS）的数据。
工作人员对艾滋病毒政策的知晓程度较高，大多数人接受过一些相关培训。奈韦拉平的服用情况因诊所而异，平均为56%。预防母婴传播存在许多错失的机会，67%的孕妇接受了艾滋病毒检测，而在前次怀孕期间接受检测的产前护理就诊者仅占43%。只有6%的艾滋病毒呈阳性妇女报告参加了支持小组。
减少预防母婴传播的错失机会需要加强正规卫生部门、部门间联络以及更多的社区支持。正规卫生部门需要加强的优先领域包括艾滋病毒咨询和检测；计划生育和营养咨询；婴儿随访；人力资源；以及监测和评价。
