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Table 1 Avoidable health personnel and systems barriers to ART and PMTCT in four facilities in South Africa: the maternal-child care continuum

From: Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry

Antenatal Care  
HEALTH PERSONNEL  
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  
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  
HEALTH PERSONNEL  
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  
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  
HIV Testing & Counselling  
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  
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)  
HEALTH PERSONNEL In which Facilities?
HIV Testing & Counselling  
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