2 research outputs found
Quality and turnaround times of viral load monitoring under prevention of mother-to-child transmission of HIV Option B+ in six South African districts with a high antenatal HIV burden
BACKGROUND : Barriers to monitoring maternal HIV viral load (VL) and achieving 90% viral suppression during pregnancy and breastfeeding
still need to be understood in South Africa (SA).
OBJECTIVES : To measure quality of VL care and turnaround times (TATs) for returning VL results to women enrolled in the prevention of
mother-to-child transmission of HIV (PMTCT) programme in primary healthcare facilities.
METHODS : Data were obtained from a 2018 cross-sectional evaluation of the PMTCT Option B+ programme in six SA districts with high
antenatal and infant HIV prevalence. Quality of VL care was measured as the proportion of clients reporting that results were explained to
them. TATs for VL results were calculated using dates abstracted from four to five randomly selected facility-based client records to report
overall facility ‘short TAT’ (≥80% of records with TAT ≤7 days). Logistical regression and logit-based risk difference statistics were used.
RESULTS : Achieving overall short TAT was uncommon. Only 50% of facilities in one rural district, zero in one urban metro district and
9 - 38% in other districts had short TAT. The significant difference between districts was influenced by the duration of keeping results
in facilities after receipt from the laboratory. Expected quality of VL care received ranged between 66% and 85%. Client-related factors
significantly associated with low quality of care, observed in two urban districts and one rural district, included lower education, recent
initiation of antiretroviral treatment and experiencing barriers to clinic visits. Experiencing clinic visit barriers was also negatively associated
with short TATs.
CONCLUSIONS : We demonstrate above-average quality of care and delayed return of results to PMTCT clients. Context-specific interventions
are needed to shorten TATs.The President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC). The publication of this manuscript was funded by the South African Medical Research Council.http://www.samj.org.zadm2022Paediatrics and Child Healt
Investigating the quality of HIV rapid testing practices in public antenatal health care facilities, South Africa
Monitoring HIV prevalence using antenatal HIV sentinel surveillance is important for efficient
epidemic tracking, programme planning and resource allocation. HIV sentinel surveillance
usually employs unlinked anonymous HIV testing which raises ethical, epidemiological and
public health challenges in the current era of universal test and treat. The World Health
Organization (WHO) recommends that countries should consider using routine prevention
of mother-to-child transmission of HIV (PMTCT) data for surveillance. We audited antenatal
care clinics to assess the quality of HIV rapid testing practices as the first step to assess
whether South Africa is ready to utilize PMTCT programme data for antenatal HIV surveillance. In 2017, we conducted a cross-sectional survey in 360 randomly sampled antenatal
care clinics using the adapted WHO Stepwise-Process-for-Improving-the-Quality-of-HIVRapid-Testing (SPI-RT) checklist. We calculated median percentage scores within a
domain (domain-specific median score), and across all domains (overall median percentage
scores). The latter was used to classify sites according to five implementation levels; (from
0:<40% to 4: 90% or higher). Of 346 (96.1%) facilities assessed, an overall median percentage score of 62.1% (inter-quartile range (IQR): 50.8–71.9%) was obtained. The lowest
domain-specific median percentage scores were obtained under training/certification (35%
IQR: 10.0–50.0%) and external quality assurance (12.5% IQR: 0.0–50.0%), respectively.
The majority (89%) of sites had an overall median score at level 2 or below; of these, 37%
required improvement in specific areas and 6.4% in all areas. Facilities in districts implementing the HIV Rapid Test Quality Improvement Initiative and supported by the President’s
Emergency Plan for AIDS Relief (PEPFAR) had significantly higher median overall scores (65.6% IQR: 53.9–74.2%) (P-value from rank sum test: <0.001) compared with non–PEPFAR–supported facilities (56.6% IQR:47.7–66.0%). We found sub-optimal implementation
of HIV rapid testing practices. We recommend the expansion of the PEPFAR-funded Rapid
Test Continuous Quality Improvement (RTCQI) support to all antenatal care testing sites.DATA AVAILABILITY STATEMENT : All data files are
available from the Figshare data repository: DOI 10.6084/m9.figshare.20257362.The United States President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC).http://www.plosone.orgdm2022Paediatrics and Child Healt