An audit of PMTCT services at a regional hospital in South Africa

Abstract

Prevention of mother-to-child transmission (PMTCT) is a major intervention world-wide in the fight against the HIV pandemic, and has resulted in markedly reduced rates of mother-to-child transmission rates in well-resourced countries. However, it seems that barriers to implementation of the programme exist at all levels of health care at all facilities providing maternal care.
Aim: To conduct a clinical audit of the PMTCT programme at a regional hospital in Pietermaritzburg, KwaZulu-Natal, South Africa.
Methods: Data was collected from an analysis of antenatal and medical records of women who attended antenatal care and delivered at the regional hospital between January and December 2007. Only pregnant women who attended antenatal care at this regional hospital and delivered in its facilities were selected for the study. Patients eligible for review were identified using the labour ward delivery log book.
Results: Of the 499 records analysed, 479 women (96%) were offered testing, of which 473 accepted. Of those tested, 227 (48%) were HIV positive. Only 15 (6.1%) of the 246 who tested negative were re-tested. CD4 counts were done for only 159 (70%) of the 227 HIV-positive women. More importantly, only 134 (84.3%) received their results. Of the 227 HIV-positive women, only 131 (57.7%) were given 200 mg nevirapine at ≥ 28 weeks gestation (to take home and swallow once they had strong labour pains); 185 (81.5%) took nevirapine before delivery (i.e. the total number of both those that took NVP < 2hrs and > 2hrs) 143 (77.3%)
took nevirapine > 2 hours before delivery and 84 (37%) took nevirapine < 2 hours before delivery. Of the babies, 208 (91.6%) were given nevirapine
within 72 hours.
Discussion: This audit shows that progress has been made in the implementation of PMTCT of HIV at this regional hospital by the high uptake of HIV testing; however, barriers to full implementation are caused by the lack of integration of testing, counselling and obtaining CD4 count results.

Keywords: audit; PMTCT services; regional hospital