Table 1 Avoidable health personnel and systems barriers to ART and PMTCT in four facilities in South Africa: the maternal-child care continuum
Antenatal Care | Â |
|---|---|
HEALTH PERSONNEL | Â |
HIV Testing & Counselling | In Which Facilities? |
HIV counsellor unavailable for testing | All four |
Repeat testing unavailable for patients who had earlier declined | All four |
Counsellor unavailable at time of HIV test | All four |
ART Eligibility/Initiation | In Which Facilities? |
Health staff miss ART eligibility in patient's file | All four |
HEALTH SYSTEM | Â |
HIV Testing & Counselling | In Which Facilities? |
No HIV test kit available | Eastern Cape clinic only |
ART Eligibility/Initiation | In Which Facilities? |
Patient file does not have CD4 cell result | All four |
Labour Ward | Â |
HEALTH PERSONNEL | Â |
HIV Testing & Counselling | In which Facilities? |
No counselling for HIV positive woman on infant testing at six weeks; ART for woman and infant; immunization; cotrimoxazole; nutrition; family planning; safer sex; partner testing | All three hospitals |
HIV Prevention | In which Facilities? |
No ARV prophylaxis given to HIV positive woman in labour | All three hospitals |
Infant not given ARV prophylaxis when mother's HIV positive status is clear | Johannesburg hospital |
HEALTH SYSTEM | In which Facilities? |
HIV Testing & Counselling | Â |
Woman with unknown HIV status not tested | All three hospitals |
Woman's HIV status unclear from file | All three hospitals |
Postnatal Care (after patient is discharged and returns for follow up care) | In which Facilities? |
HEALTH PERSONNEL | Â |
HIV Testing & Counselling | Â |
Woman with unknown HIV status not tested | All three hospitals |
HIV positive woman fails to take child for PCR test | Johannesburg and Eastern Cape academic hospitals (only these facilities offer PCR testing) |
HEALTH SYSTEM | Â |
ART Eligibility/Initiation | In which Facilities? |
Woman with HIV does not receive CD4 cell test | All three hospitals |
Paediatric Ward (only pertains to Eastern Cape Academic Hospital and Johannesburg Hospital) | Â |
HEALTH PERSONNEL | In which Facilities? |
HIV Testing & Counselling | Â |
HIV-exposed child admitted for TB not tested for HIV | Johannesburg hospital |
HIV positive child's mother with status unknown not referred for HIV testing | Johannesburg and Eastern Cape academic hospitals |
ART Eligibility/Initiation | In which Facilities? |
ART eligibility of mother (with HIV positive child unknown) | Johannesburg and Eastern Cape Academic hospitals |