Prevention of Mother-to-Child Transmission of HIV/AIDS (PMTCT) (Archived)

1. Monitoring and Evaluation of the PMTCT programme
HST has been involved in ongoing monitoring and evaluation of the PMTCT programme since its inception in 2001. Our role has involved technical support for the development of guidelines, the development of a research framework and support to provincial PMTCT co-ordinators in terms of information management and training.

Over the period of 2002, three consultants were sub-contracted by HST to facilitate the collection and analysis of routine data from the 18 pilot sites. A PMTCT information systems module was created for the pilot sites using the DHIS software.

The first formal evaluation of the PMTCT programme was undertaken in 2001 and a report was release in early 2002. A second evaluation that includes the process underway in the provinces to expand this programme was conducted in late 2003 and a report is due to be released soon.

2. National PMTCT Cohort Study
The aim of this study is to investigate infant feeding patterns and behaviours of HIV+ and HIV- mothers postnatally and to describe and measure the impact of the PMTCT programme on the health of infants born to HIV positive mothers.

The study began recruiting women in September 2002. The study is being conducted in three purposively selected sites: Paarl (Western Cape), Umlazi (KwaZulu-Natal) and Rietvlei (Eastern Cape).

The cohort study is being coordinated and managed by the Health Systems Trust, under the direction of Ms Tanya Doherty. Technical input into the study design and project management has been provided by the Public Health Programme of the University of the Western Cape and the Medical Research Council.

Laboratory support (HIV testing) is being provided by the Virology Department of the University of Natal. Quality assurance of the field procedures is being managed by the Medical Research Council. Quality assurance of the laboratory procedures is being conducted by the Africa Centre.

3. Cohort Sub-studies

A number of sub-studies have been built into the national PMTCT cohort.

  1. An observational study of the quality of ante-natal counselling and education on infant feeding in all three cohort sites.
  2. An in-depth sociological study of the factors determining infant feeding behaviour in all three sites.

The first sub-study is an observational study of PMTCT counselling involving direct observation of counselling sessions and exit interviews with women. The study aims to provide a baseline on the quality of counselling provided in the PMTCT programme. Data collection for this study is complete and the final report is being written.

The second sub-study is a qualitative study of infant feeding decision-making. It will involve longitudinal interviews with index types of women recruited according to their antenatal infant feeding intensions. Regular interviews will be conducted with participants between birth and 4 months in order to track infant feeding decisions and to determine the impact of factors such as disclosure on decision making. The study will begin in September 2003.

These cohort sub-studies are being co-funded by the World Health Organisation.

4. PMTCT Capacity Development Tender
HST is part of a consortium together with the Women's Health Project and the University of the Western Cape that was awarded a tender by the DoH to assist provinces in developing plans for PMTCT training and to evaluate current training initiatives. As part of this work, the consortium has assisted in the development of a PMTCT training manual. The manual has been field tested in Kwazulu-Natal and Mpumalanga and is in the process of being finalised.

This tender is funded by the CDC and will be complete in September 2003.

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