Implementation and experiences of integratedprevention of mother-to-child transmissionservices in Tanzania, Malawi and South Africa: Amixed methods study

Citation: 
Farida Hassan , Jenny Renju , John Songo , Rujeko Samanthia Chimukuche ,Thokozani Kalua , Estelle McLean , Lameck Luwanda , Eveline Geubbels ,Janet Seeley , Mosa Moshabela , Deborah Kajoka & Alison Wringe
Publication year: 
2020

Although integration of HIV and maternal health services is recommendedby the World Health Organization, evidence to guide implementation islimited. We describe facility-level implementation of policies forintegrating HIV care within maternal health services and exploreexperiences of service users and providers in rural Tanzania (Ifakara),South Africa (uMkhanyakude) and Malawi (Karonga). Policy in allcountries included HIV testing during antenatal care (ANC), same-dayantiretroviral 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 offeredHIV testing within ANC, most commonly during thefirst visit. Althoughmost women were comfortable with HIV testing, some felt that optingout would lead to sub-standard services. Some facilities conductedgroup post-test counselling for HIV-negative women, raising concernsof unintended HIV status disclosure. ART initiation was offered on thesame day, the same room as an HIV diagnosis in >90% of facilities.Womens worries around postpartum referral included having unknownproviders, insufficient privacy and queues. Adoption andimplementation of policies on integrated HIV and maternal healthservices varied across settings. Patientsexperiences of these policiesmay influence uptake and retention in care.