Population Council Research that makes a difference

XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010

Abstract

"Strengthening PMTCT in antenatal and postnatal care services in KwaZulu-Natal"
Hlamalani Mabasa, Saiqa Mullick, Edwin Maroga, Mhlahlandlela Mabena, Doctor Khoza, and Mantshi Teffo-Menziwa

Background
HIV prevalence in pregnant women is 28 percent nationally with KwaZulu-Natal (KZN) province having the highest (37.4%). Maternal mortality has increased by 20.1 percent from 2005, and AIDS is the leading cause (43.7%) (Saving Mothers 2007). KZN has the highest maternal mortality (340/1,000). The Population Council in collaboration with KZN provincial DOH developed evidence-based antenatal (ANC) and postnatal care (PNC) policy and guidelines. The policy and guidelines integrate comprehensive HIV into ANC and PNC care and establish a postnatal framework for strengthening PMTCT. This is an evaluation of the guidelines on the quality of PMTCT.

Methods
A pre-/post-intervention design was used. The study was conducted in three districts, Amajuba, Zululand, and Umkhanyakude (three facilities per district). Structured client–provider observations of ANC first visit, repeat visit, and postnatal visit were also conducted. Assessments of the quality of care were conducted before and after the training of health care providers.

Results
Antenatal observations revealed a significant increase in clients that recently had a CD4 count test from 42 percent to 58 percent. Providers asking clients about knowing partner's HIV status increased from 41 percent to 59 percent. Discussion of infant feeding also increased from 42 percent to 58 percent. Provider mentioning PMTCT increased significantly from 40 percent to 60 percent. Results showed an increase in discussing the following during PNC: PMTCT (28%–31%), HIV testing (39%–42%), finding out if client had CD4 count testing (22%–27%), multiple sexual partners (16%–25%) and asking whether partner's status is known (8%–14%). Onsite PCR testing increased significantly (12%–88%) as did referrals for PCR testing (25–74%). Prescription of bactrim for the baby also increased from 3 percent to 15 percent.

Conclusions
The results suggest that the training on the guidelines was effective in improving the quality of care and strengthening PMTCT services in ANC and PNC settings.

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