Graduate School of Business Administration, University of the Witwatersrand, Johannesburg, South Africa.
AIDS Res Ther. 2011 Mar 3;8:10. doi: 10.1186/1742-6405-8-10.
HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. To address these avoidable deaths, eligibility criteria for antiretroviral therapy (ART) in pregnant women were revised in 2010 to enhance ART coverage. With greater availability of HIV services in public health settings and increasing government attention to poor maternal-child health outcomes, this study used the patient's journey through the continuum of maternal and child care as a framework to track and document women's experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT) programmes in the Eastern Cape (three peri-urban facilities) and Gauteng provinces (one academic hospital).
In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation). By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner's reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate.
A single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays, when concurrent, often signalled wholesale denial of prevention and treatment. There is great scope for health systems' reforms to address constraints and weaknesses within PMTCT and ART services in South Africa. Recommendations from this study include: ensuring autonomy over resources at lower levels; linking performance management to facility-wide human resources interventions; developing accountability systems; improving HIV services in labour wards; ensuring quality HIV and infant feeding counselling; and improved monitoring for performance management using robust systems for data collection and utilisation.
艾滋病毒仍然导致南非孕妇及其儿童死亡的 40%左右。为了避免这些死亡，2010 年修订了孕妇抗逆转录病毒治疗（ART）的资格标准，以提高 ART 的覆盖面。随着公共卫生环境中提供更多的艾滋病毒服务以及政府对母婴健康不良结果的日益关注，本研究以孕产妇和儿童保健服务连续体中的患者旅程为框架，跟踪和记录妇女获得 ART 和预防母婴传播艾滋病毒（PMTCT）方案的经验，在东开普省（三个城市周边设施）和豪登省（一家学术医院）进行。
深入访谈确定了运营性艾滋病毒服务提供方面的相当多弱点。这些表现为由于缺乏检测试剂盒，在产前保健中错过了艾滋病毒检测的机会；分配给艾滋病毒服务的工作人员不足；未能按时向辅导员支付工资，导致其缺勤；以及未能及时将 CD4 细胞计数结果转录到患者档案中（启动 ART 所需）。相比之下，破坏获取途径的个人因素包括对阳性检测结果或伴侣反应的心理社会问题；和耻辱感。三个城市周边设施的监测数据和信息系统明显不足。
单一系统或个人层面的延迟降低了妇女获得 ART 或 PMTCT 干预的可能性。这些延迟，如果同时发生，通常表示全面拒绝预防和治疗。南非在 PMTCT 和 ART 服务方面有很大的空间进行卫生系统改革，以解决限制和弱点。本研究的建议包括：确保在较低层次上对资源的自主权；将绩效管理与全设施人力资源干预措施联系起来；制定问责制度；改善劳动病房的艾滋病毒服务；确保高质量的艾滋病毒和婴儿喂养咨询；以及通过使用强大的数据收集和利用系统改进绩效管理监测。
