Challenges to delivering quality care in a prevention of mother-to-child transmission of HIV programme in Soweto

Background. There has been little focus on the quality of care provided in the prevention of mother-to-child transmission (PMTCT) of HIV services in South Africa (SA). Objective. To assess the quality of care in PMTCT services in Soweto, SA, focusing on the knowledge and experiences of healthcare workers and HIV-infected pregnant women accessing the services. Methods. A cross-sectional survey was conducted in November - December 2009. A total of 201 HIV-infected pregnant women and 80 healthcare workers from 10 antenatal clinics were interviewed using standardised questionnaires. Results. Among the HIV-infected pregnant women, the median gestational age was 20 weeks at the first antenatal visit and 32 weeks at the time of the interview. The majority of the women interviewed (71.5%) discovered that they were HIV-infected in the index pregnancy, and 87.9% disclosed their HIV status. Overall, 97.5% received counselling and 33.5% were members of a support group. Knowledge of antenatal and intra-partum PMTCT interventions was accurate in 62.7% and 43.3% of the women, respectively. Support group membership and current use of antiretroviral prophylaxis did not impact on the quality of knowledge. Of the healthcare workers, 43.8% were professional nurses and 37.5% were lay counsellors. The majority (80.0%) felt satisfied with their knowledge of the PMTCT guidelines and 96.3% felt competent in managing HIV-infected pregnant women. Yet, there were important deficiencies in the knowledge of the guidelines. Conclusion. In our study, the knowledge of PMTCT interventions was low in both clients and healthcare workers. This points to the need to improve quality of care in PMTCT services, especially with increasingly complex PMTCT interventions recommended by international policies.