Implementation and experiences of integrated prevention of mother-to-child transmission services in Tanzania, Malawi and South Africa: A mixed methods study

ABSTRACT

Although integration of HIV and maternal health services is recommended by the World Health Organization, evidence to guide implementation is limited. We describe facility-level implementation of policies for integrating HIV care within maternal health services and explore experiences of service users and providers in rural Tanzania (Ifakara), South Africa (uMkhanyakude) and Malawi (Karonga). Policy in all countries included HIV testing during antenatal care (ANC), same-day antiretroviral therapy (ART) initiation for HIV-positive pregnant women, and postpartum referral to ART clinics, between six weeks (Malawi, South Africa) and two years after delivery (Tanzania). All facilities offered HIV testing within ANC, most commonly during the first visit. Although most women were comfortable with HIV testing, some felt that opting out would lead to sub-standard services. Some facilities conducted group post-test counselling for HIV-negative women, raising concerns of unintended HIV status disclosure. ART initiation was offered on the same day, the same room as an HIV diagnosis in >90% of facilities. Women’s worries around postpartum referral included having unknown providers, insufficient privacy and queues. Adoption and implementation of policies on integrated HIV and maternal health services varied across settings. Patients’ experiences of these policies may influence uptake and retention in care.

KEYWORDS:

• Integration
• Option B+
• maternal health services
• HIV care
• sub-Saharan Africa

Acknowledgements

We would like to acknowledge Kathryn Church and Aisha N. Z. Dasgupta for their work in the first two rounds of policy reviews and facility surveys. This work was supported by the Medical Research Council, through a Health Systems Research Initiative grant [grant number MR/ P014313/1]. JR receives funding support from DELTA/THRIVE under DEL15-011/07742/Z/15/Z. Study participants from three HDSS settings for willingness to participate in the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Medical Research Council, United Kingdom, through a Health Systems Research Initiative grant [grant number MR/P014313/1]. JR receives funding support from DELTA/THRIVE under DEL15-011/07742/Z/15/Z.