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

Figures & data

Table 1. Health facility and in-depth interview participant’s characteristics.

Country		Malawi	Tanzania	South Africa	Total
HDSS site		Karonga	Ifakara	uMkhanyakude
Facility survey
Total number of facilities		5	11	17	33
Facility type
	Dispensary/small clinic	0	2	10	12
	Large clinic/small health centre	3	4	7	14
	Large health centre/sub-district hospital	2	3	0	5
	District hospital	0	1	0	1
	Referral hospital	0	1	0	1
Ownership
	Government	3	9	17	29
	Faith based	2	1	0	3
	Private	0	1	0	1
Indepth Interviews
Total number of facilities		3	3	3	9
Service users
PMTCT B± service users: HIV positive pregnant and postpartum women		5	8	8	21
ANC users: HIV negative pregnant women		5	4	6	15
HIV routine service users: HIV positive postpartum women graduated from PMTCT		7	4	6	17
PMTCT lost to follow up: HIV positive pregnant and postpartum women disengaged from treatment		5	2	6	13
Total number of service users from all groups		22	18	26	66
Health workers
HTS counsellor		1	0	0	1
Nurse-midwife technician		3	4	0	7
HIV diagnostic assistant		1	0	0	1
Expert client		2	0	0	2
Professional nurse		0	1	5	6
Enrolled nurse		0	0	1	1
Nurse Assistant		0	2	0	2
Total of health workers all cadre		7	7	6	20
TOTAL FOR ALL INTERVIEWS		29	25	32	86

Figure 1. HIV care cascade indicators for pregnant and postpartum women; black squares denote the policy detail aligns with the specification listed.

Table 2. Three countries policy analysis on pregnant or postpartum HIV testing, treatment initiation and referral to adult ART clinics.

Indicators	WHO	Tanzania	Malawi	South Africa
Testing	PITC for women should be considered a routine component of the package of care in all antenatal, childbirth, postpartum and paediatric care settings	All pregnant women and their partners (unless known to be HIV positive) should be counselled and tested for HIV during their first ANC visit	Review HIV testing page in health passport on admission … Provide new HIV test for all women, who are: Not already known to be HIV positive; Never tested or tested negative any time in the past, even if this result is from the last trimester’ Remind patients during pre-test education (group or individual) that they can decline HIV testing without any ‘fear of punishment’ by the health worker	All pregnant women should retest for HIV at the time of the diagnosis of pregnancy, every visit during pregnancy, at delivery, and every three months during breastfeeding. Pregnant women should be tested as early as possible in each pregnancy.
Date and source	ART guideline 2016	NMHIVAIDS2017	MIG 2016	National HIV counselling and Testing policy 2016
Treatment initiation	ART should be initiated in all pregnant and breastfeeding women living with HIV at any CD4 cell count and continued lifelong and HIV treatment should be given on same day as ANC services	Care and treatment services for pregnant and breastfeeding women living with HIV should be provided in RCH settings or by referral when care and treatment services cannot be provided in RCH clinics. Lifelong ART is recommended for all HIV-positive pregnant and breastfeeding women regardless of their CD4 count or WHO clinical stage or gestational age	All women attending antenatal care (both first-time attendees and women attending follow up visits) should be given routine information about HIV testing and the PMTCT programme’. ‘All pregnant women should retest for HIV at the time of the diagnosis of pregnancy, every visit during pregnancy, at delivery, and every three months during breastfeeding	Initiate lifelong ART in all pregnant or breastfeeding women on the same day of diagnosis regardless of CD4 count
Date and source	ART guideline 2015	NMHIVAIDS2017	MIG 2016	NCGPMTCT 2015
Transfer to routine HIV care	Strongly recommends establishing referral systems to facilitate decentralisation and linkage of care but does not give specifics on procedures. Clear guidance should be given as to when HIV-positive pregnant women referred to ART clinic.	Standard of care, mother-child follow-up in RCH will continue until the child attains the age of 2 years.	Not specified	Women who are put on at FDC (TDF+3TC (FTC)+EFV) in their pregnancy should be monitored and managed, where possible, by the same provider in the same facility through the antenatal and postnatal periods until the end of breastfeeding (18 months). They should then be referred to appropriate services to continue lifelong ART as part of the general adult ART population.
Date and source	ART guideline 2016	NMHIVAIDS2017	NCGPMTCT 2015

Figure 2. When and where HIV testing services were offered in relation to MNCH as reported from 5 facilities in Karonga, 11 in Ifakara and 14 in uMkhanyakude.

Figure 3. Timing of HIV test in relation to pregnancy care as reported from 5 facilities in Karonga, 11 in Ifakara and 14 in uMkhanyakude.

Figure 4. Additional services offered within an integrated PMTCT and MNCH service as reported from 5 facilities in Karonga, 11 in Ifakara and 14 in uMkhanyakude.

Figure 5. Timing of transfer to routine ART care and checks carried out to ensure transfer has taken place as reported from 5 facilities in Karonga, 11 in Ifakara and 14 in uMkhanyakude.

Figure 6. Facilities reporting to conduct checks to see if a woman has successfully transferred from PMTCT to routine ART care as reported from 5 facilities in Karonga, 11 in Ifakara and 14 in uMkhanyakude.