Lungiswa Nkonki and colleagues, examined missed opportunities for participation in prevention of mother-to-child transmission(PMTCT)programmes in three sites in South Africa.
They recruited 58 HIV-positive women who were then enrolled in a larger trial looking at mother-to-child HIV transmission. A total of 15 women missed their treatment with the drug nevirapine, used to prevent HIV transmission during pregnancy and birth. According to the study there was a chain of missed opportunities that led to this outcome. For example, six of the women were not tested because of lack of counsellors or supplies of testing materials. Two of the 15 women did not receive their HIV test results until after delivery. In both instances the women had attended antenatal clinics regularly, but health workers failed to give them the nevirapine in time. Seven of the 15 women recieved their results but did not take their nevirapine - three of these women either lost their tablet, didn't take it during labour as required because of a hard labour or did not believe their test results. Five of these seven women were directly failed by the health system, including getting incorrect instructions about how to take the tablet.
As the authors point out, a lot is said about fear of knowing HIV status and disbelief of test results as important reasons for people dropping out of PMTCT programmes. But, this study found that these were not common reasons for prevention failure. In fact, 40% of the women enrolled had not even been tested due to health system failure. Health system constraints, including lack of counsellors and testing equipment were the key reasons for lost opportunities. Nothing much appears to have changed since the early studies of pilot programmes of PMTCT - which also found lack of counsellors and testing equipment.
