Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many problems, including the inconsistent availability of HIV testing and antiretroviral drugs at program sites and the deficit in training and supervision for PMTCT. Clients interviewed after their contact with providers often complained about the lack of information received about PMTCT. They considered that effective integration of these services would provide them with better quality care while reducing their waiting time, costs, and trips to health facilities. The responses of policymakers and program managers interviewed mostly revealed gaps in their understanding and implementation of the integration. There is an effort to integrate MNCH/RH and PMTCT services at the healthcare facilities we visited. But our investigation revealed many shortcomings in both the screening and support of new or expectant HIV+ mothers. To improve this situation it is necessary to improve the skills and motivation of PMTCT providers, enhance the level of equipment, and empower local maternity wards.