The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

doi:10.1080/17290376.2017.1375425

. 2017 Dec;14(1):38-52.

doi: 10.1080/17290376.2017.1375425.

The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

Affiliations

¹ a MSEd is a Senior Research Associate at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
² b BA, is a Volunteer Research Assistant at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
³ c is a senior undergraduate student in the Department of Biology and Research Assistant in the, Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
⁴ d BS, is a third-year medical student at the University of Miami Miller School of Medicine , Miami , FL , USA and pursuing joint Doctor of Medicine and Master of Public Health degrees.
⁵ e PhD, is a distinguished research fellow in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁶ f MPH, is a Senior Researcher/PHD research trainee in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁷ g BA(Hons), is a Project Supervisor in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁸ h MDevSt, is a Research Specialist in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁹ i PhD, MPH, is Chief Research Specialist at the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
¹⁰ j PhD, is the Dean of the Graduate School, the Leonard M. Miller Professor of Public Health Sciences , Miami , FL , USA.
¹¹ k MD, is Associate Professor at the Department of Public Health Sciences , University of Miami, Miller School of Medicine , Miami , FL , USA.
¹² l MD, is a Professor at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
¹³ m is a Professor at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.

PMID: 28922974
PMCID: PMC5638135
DOI: 10.1080/17290376.2017.1375425

The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

Violeta J Rodriguez et al. SAHARA J. 2017 Dec.

. 2017 Dec;14(1):38-52.

doi: 10.1080/17290376.2017.1375425.

Authors

Affiliations

¹ a MSEd is a Senior Research Associate at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
² b BA, is a Volunteer Research Assistant at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
³ c is a senior undergraduate student in the Department of Biology and Research Assistant in the, Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
⁴ d BS, is a third-year medical student at the University of Miami Miller School of Medicine , Miami , FL , USA and pursuing joint Doctor of Medicine and Master of Public Health degrees.
⁵ e PhD, is a distinguished research fellow in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁶ f MPH, is a Senior Researcher/PHD research trainee in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁷ g BA(Hons), is a Project Supervisor in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁸ h MDevSt, is a Research Specialist in the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
⁹ i PhD, MPH, is Chief Research Specialist at the HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.
¹⁰ j PhD, is the Dean of the Graduate School, the Leonard M. Miller Professor of Public Health Sciences , Miami , FL , USA.
¹¹ k MD, is Associate Professor at the Department of Public Health Sciences , University of Miami, Miller School of Medicine , Miami , FL , USA.
¹² l MD, is a Professor at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.
¹³ m is a Professor at the Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA.

PMID: 28922974
PMCID: PMC5638135
DOI: 10.1080/17290376.2017.1375425

Abstract
in English, French

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff-patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

Le programme conjoint des Nations Unies sur le VIH et le SIDA avait proposé de réduire les chiffres de transmission verticale du VIH de 72.000 à 8.300 chez de nouveaux enfants infectés en Afrique du Sud tout au long 2015. Cependant, les obstacles culturels, des infrastructures, et socioéconomiques ont empêché la mise en route du protocole de prévention de la transmission mère-enfant (PTME). D’autre part, la recherche de solutions possibles pour éviter ces obstacles dans des milieux ruraux est spécialement limitée. Cette étude est orientée à l’identification des difficultés et des solutions pour la mise en route, adaptation et soutenabilité du protocole PTME dans des régions rurales d’Afrique du Sud. Dans ce but, l’étude a compris 45 interviews qualitatives, 12 group de discussion (n = 75) et un workshop de deux journées (n = 32 participants) développés avec la participation des directeurs de district, des cliniciens responsables, personnel d’aide et des patients de 12 cliniques rurales. La livraison et l’acceptation du protocole PTME ont été évaluées en accord avec le CFIR (Consolidated Framework for Implementation Research) : 15 sujets associés aux difficultés et aux solutions sont apparus. La révélation de l’entrainement dans le protocole PTME et du status sérique VIH sont des sujets caractéristiques de l’intervention. La disponibilité d’espace, le traitement et contrôle des histoires cliniques et la limitation de moyens humains peuvent être considérés comme des aspects moins directs, tandis que l’usage et la disponibilité de ressources matérielles, les relations entre le personnel qualifié et le patient, le transport et son horaire sont des aspects de contrôle plus directs. Les aspects qui sont d’avantage en rapport avec les caractéristiques individuelles de chaque patient incluent les relations avec le personnel qualifié, la visite initiale de soin prénatale, l’adhésion au protocole, la culture et les stigmas. L’éducation du patient, la livraison des résultats des tests et le compromis masculin sont les aspects le plus importants pour la mise en marche du processus. Quelques lacunes dans l’application des soins ont été identifiées dans des régions rurales. Néanmoins, l’information obtenue des participants qui ont utilisé the schéma CFIR a fourni des données très précieuses pour trouver des solutions aux problèmes de la mise en route du protocole PTME. Dans le but d’améliorer au maximum la prévention du VIH, il est très important de suivre de très près le protocole PTME pour appliquer les corrections, adaptation et soutenabilité nécessaires

Keywords: Afrique du Sud; HIV; PMTCT; South Africa; VIH et le SIDA; implementation research; implementation science; prévention de la transmission mère-enfant (PMTE).

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References

1. Amnesty International (2014). Struggle for maternal care: Barriers to antenatal care in South Africa. Retrieved from http://www.amnesty.org/en/death-penalty/abolitionist-and-retentionist-co...
1. Barker P. M., Mphatswe W., & Rollins N. (2011). Antiretroviral drugs in the cupboard are not enough: The impact of health systems’ performance on mother-to-child transmission of HIV. Journal of Acquired Immune Deficiency Syndromes, (2), e45–e48. - PubMed
1. The CDI Study Group Adlai. (2010). Community-directed interventions for priority health problems in Africa: Results of a multicountry study. Bulletin of the World Health Organization, (7), 509–518. - PMC - PubMed
1. CFIR (2014). Consolidated framework for implementation research guide. Retrieved from http://cfirguide.org/index.html
1. Damschroder L. J., Aron D. C., Keith R. E., Kirsh S. R., Alexander J. A., & Lowery J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, (1), 886. - PMC - PubMed

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[1] Amnesty International (2014). Struggle for maternal care: Barriers to antenatal care in South Africa. Retrieved from http://www.amnesty.org/en/death-penalty/abolitionist-and-retentionist-co...

[2] Amnesty International (2014). Struggle for maternal care: Barriers to antenatal care in South Africa. Retrieved from http://www.amnesty.org/en/death-penalty/abolitionist-and-retentionist-co...

[3] Barker P. M., Mphatswe W., & Rollins N. (2011). Antiretroviral drugs in the cupboard are not enough: The impact of health systems’ performance on mother-to-child transmission of HIV. Journal of Acquired Immune Deficiency Syndromes, (2), e45–e48. - PubMed

[4] Barker P. M., Mphatswe W., & Rollins N. (2011). Antiretroviral drugs in the cupboard are not enough: The impact of health systems’ performance on mother-to-child transmission of HIV. Journal of Acquired Immune Deficiency Syndromes, (2), e45–e48. - PubMed

[5] The CDI Study Group Adlai. (2010). Community-directed interventions for priority health problems in Africa: Results of a multicountry study. Bulletin of the World Health Organization, (7), 509–518. - PMC - PubMed

[6] The CDI Study Group Adlai. (2010). Community-directed interventions for priority health problems in Africa: Results of a multicountry study. Bulletin of the World Health Organization, (7), 509–518. - PMC - PubMed

[7] CFIR (2014). Consolidated framework for implementation research guide. Retrieved from http://cfirguide.org/index.html

[8] CFIR (2014). Consolidated framework for implementation research guide. Retrieved from http://cfirguide.org/index.html

[9] Damschroder L. J., Aron D. C., Keith R. E., Kirsh S. R., Alexander J. A., & Lowery J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, (1), 886. - PMC - PubMed

[10] Damschroder L. J., Aron D. C., Keith R. E., Kirsh S. R., Alexander J. A., & Lowery J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, (1), 886. - PMC - PubMed

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The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

Affiliations

The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

Authors

Affiliations

Abstract
in English, French

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Cited by

References

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Medical

Abstract in English, French

Similar articles

Cited by

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Medical

Abstract
in English, French