Promoting Awareness of the Role of the District Clinical Specialist Team in the Amathole District, South Africa: A Valuable Specialty in Improving Healthcare Access and Quality.

INTRODUCTION: This study explored the understanding of healthcare professionals on the role of the District Clinical Specialist Team (DCST) and how the team works together with the district personnel at different management levels to improve and strengthen the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme performance across four sub-districts in the Amathole district of the Eastern Cape Province, South Africa. METHODS: An interpretive qualitative case study was used to understand the role played by the DCST in improving PMTCT programme performance in the district. We used a purposive sampling method to select eight participants involved in providing technical assistance to support the implementation of the quality improvement programme. We conducted in-depth interviews with all the participants; all were females in their mid-forties. Data were analysed thematically by identifying themes and reporting patterns within the data. FINDINGS: Most interviewees were females in their mid-forties and had been at their respective facilities for at least five years. The findings were discussed based on three themes: capacity building, programme performance oversight and monitoring, and technical support. The DCST significantly enhances the staff's clinical skills, knowledge, and work performance to care for and manage the mother and baby pair. In addition, the DCST plays a vital role in providing programme oversight and complements the technical support provided by the Department of Health (DoH) managers and the quality improvement programme support by the South to South (S2S) team aimed at improving and achieving the PMTCT programme's desired outcomes. The DCST also provided additional support for data verification to identify gaps in the PMTCT programme. CONCLUSION: The role of DCST is essential in improving the quality and service provision of the PMTCT programme and is critical to assist the team at different levels in addressing challenges encountered and training and mentoring the needs of the staff. In addition, DCST's responsibilities cannot be fully achieved without a good working relationship with the quality improvement and district health teams because they work better together to ensure that the programme is performing optimally. TAKE-HOME MESSAGE: This study showed that the District Clinical Specialist Team is vital for improving the quality and service provision of the PMTCT programme and it is essential for addressing challenges encountered by healthcare facilities and the staff providing PMTCT services.

The association between HIV status and antenatal care attendance among pregnant women in rural hospitals in Lesotho.

OBJECTIVE: Early and frequent antenatal clinic (ANC) attendance is important for promotion of healthy outcomes for mother and child. This study explored the relationship between HIV status at the first ANC visit and subsequent ANC attendance among pregnant women in Lesotho. METHODS: A retrospective review of ANC records from a cohort of pregnant women attending their first ANC visit in December 2009 to May 2010 in 3 rural hospitals was conducted. Wilcoxon rank sum tests compared the distribution of gestational age (GA) and ANC visit number by HIV status. RESULTS: Records from 728 women were reviewed with mean GA at the first ANC visit of 22.3 weeks (SD = 7.2) and 2.7 (SD = 1.4) mean number of ANC visits per woman. Neither number of visits nor GA at first visit differed between HIV-positive and HIV-negative women. In total, 33.9% of women completed 4 ANC visits. Women with documented HIV-positive status before ANC were more likely to present early to ANC than all other women (18.8 vs. 22.6 weeks, adjusted odds ratio = 2.54, 95% confidence interval: 1.41 to 4.57). Geographical region, increasing maternal age, and lower parity were associated with completion of expected ANC visits among all women. Increasing maternal age and CD4 count were associated with completion of expected visits among HIV-positive women. CONCLUSIONS: In Lesotho, number of subsequent visits did not differ between women testing HIV-positive and HIV-negative in ANC. However, women with documented HIV-positive status attended ANC earlier than women who were tested in ANC. HIV testing and counseling, particularly for HIV-positive women before pregnancy, can promote early ANC attendance.

Preventing tuberculosis among HIV-infected pregnant women in Lesotho: the case for rolling out active case finding and isoniazid preventive therapy.

BACKGROUND: The Lesotho Ministry of Health issued guidelines on active case finding (ACF) for tuberculosis (TB) and isoniazid preventive therapy (IPT) in April 2011. ACF has been recommended in maternal and child health (MCH) settings globally, however, the feasibility of implementing IPT within MCH in countries with high concurrent HIV and TB epidemics is unknown. DESIGN/METHODS: The study evaluated the implementation of ACF and IPT guidelines in MCH settings in 2 health facilities in Lesotho. This descriptive prospective study analyzed data collected during routine services. Categorical data and continuous variables were summarized using descriptive statistics. The χ test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. RESULTS: Data from 160 HIV-positive and 640 HIV-negative women were reviewed. Within this study population, 99.8% of women were screened for TB, and 11.4% HIV-positive women compared with 2.3% HIV-negative women were reported to have symptoms of TB (P < 0.001). IPT was initiated in 124/158 (78.5%) HIV-positive pregnant women, 64.5% women completed a 6-month IPT regimen, 2 (1.6%) died of causes unrelated to IPT/TB, and 31.5% were lost to follow-up. Predictors of IPT initiation among HIV-positive women included gestational age at the first antenatal visit (unadjusted odds ratio, -0.93; 95% confidence interval: -0.88 to 0.98), and receipt of antiretroviral therapy for treatment rather than for prevention of mother-to-child transmission prophylaxis only (odds ratio, 4.59; 95% confidence interval: 1.32 to 15.93). CONCLUSIONS: Implementation of ACF and IPT is feasible within the MCH setting. Uptake of IPT during pregnancy among HIV-positive women was high, but with a high rate of loss to follow-up.