Patients’ Voices Matter: HIV infected women in South Africa

The Option B+ PMTCT programme for HIV infected women at the Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa

Background

South Africa’s National Department of Health has adopted World Health Organization’s (WHO) 2013 consolidated guidelines on the use of ARVs for treatment and prevention of HIV infection. The guidelines include changes for prevention of mother to child transmission (PMTCT) through Option B+. Option B+ aims to reduce the HIV prevalence rate amongst these women by placing them on ART for life, no matter their CD4 count. As a result, in January 2015, these guidelines were implemented for the PMTCT programme at RMMCH. Little is known about the impact of these new guidelines on the work of healthcare professionals in state hospitals. Most importantly, no research has focused on how these changes have affected adherence for the patients.

Purpose

The purpose of my research project was (1) to explore the impact of the Option B+ PMTCT programme on the work of healthcare professionals, and (2) to understand pregnant HIV-positive women views and experiences with ART for life, as a way to better manage the Option B+ PMTCT programme. Methods. Qualitative interviews were used with a phenomenological approach. The methodology uses demographic questionnaires and semi-structured interviews with healthcare professionals and patients. The study is situated in Johannesburg, South Africa.

Findings

The findings demonstrate that work has changed and become difficult to manage for all healthcare professionals because of (1) the need for strengthening indicators for tracking to decrease loss to follow-up (LTFU); (2) inconsistency in delivery of counseling and support services and the need for communication across clinical departments; and (3) the lack of compassion and understanding by service providers. The difficult healthcare environment has affected overall views and experiences of pregnant HIV-positive women going on ART for life. All patient participants responded that they chose to take the fixed-dose combination (FDC) for life to protect the health of the baby and felt ART for life can be stopped after giving birth, unaware of the long-term benefits to the mother.

Conclusion

Implications for future research include the need to address changes within the healthcare system at both clinical and management levels. It is crucial to incorporate the perspective of patients in policy implementation; uptake and adherence are key indicators in informing whether the Option B+ PMTCT programme is being adapted into state hospitals effectively. There needs to be extensive research on how to strengthen indicators for long term scalability and sustainability of the programme. Future evaluations need to address whether interdisciplinary collaboration within hospitals would improve the management and understanding of Option B+.

Melanie Bisnauth

Melanie Bisnauth is PhD student at the University of Witwatersrand, South Africa in the School of Public Health currently working with Rahima Moosa Mother & Child Hospital, ES Research Unit in PMTCT programming and services to migrant HIV-positive women. She currently is a Public Health Technical Advisor for Anova Health Institute and USAID. She served previously as a Research Coordinator in the Department of Physical Therapy at the University of Toronto and CIHRRC Coordinator.
Melanie is very passionate in providing a platform for marginalized women to voice their experiences about the barriers they face when accessing HIV/AIDS health care services.

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