Programme to improve implementation of the Prevention of Mother to Child Transmission of HIV in Gert Sibande district in Mpumalanga, South Africa: baseline report: Gert Sibande PMTCT programme implementation

Background: A baseline assessment of the PMTCT programme was conducted in the Gert Sibande district of Mpumalanga province in 2008-9 to gather information on the status of PMTCT programme implementation at all Gert Sibande health facilities prior to initiating programme strengthening activities. Identified gaps in the PMTCT programme were staff shortage, lack of guidelines, stock outs, no monitoring and evaluation system, lack of training and poor data collection methods. Interventions to address identified gaps are currently in progress. This report presents the baseline assessment results.The assessment comprised * Facility and * Client assessmentsMethods: A baseline rapid assessment was conducted by trained researchers in the formal health sector with pregnant mothers and mothers with infants between 3 months and 8 months of age. (a) Interventions to strengthen PMTCT programme implementation(b) Monitoring and evaluation support.Key findingsFacility assessmentsFew facilities had all the required national guidelines/protocols/policies on HIV management. More than half of facilities did not have all provincial guidelines/protocols/policies. 48 out of 75 facilities had the updated PMTCT guideline. Facilities generally had IEC materials. Seventy out of 75 facilities conducted on-site HIV testing and 68 had VCT services daily. Refusals on HIV testing by clients was reported by 62 facilities. Reasons stated by clients for refusal of testing were: * fear of the outcome, * client not ready for results,* client scared of the test and * some needed time to think.Refusal of testing needs further investigation as the case registers does not distinguish clients who were tested during the previous pregnancy from new clients. Therefore, some clients might have refused because they have been tested before. All facilities had at least one PN responsible for HIV testing, except in Lekwa and Albert Luthuli. The need for training of staff on PMTCT/VCT was high in all sub-districts. S