Abstract:
In January 2015, the South African National Department of Health released new consolidated
guidelines for the prevention of mother to child transmission (PMTCT) of HIV, in line with
the World Health Organization’s (WHO) PMTCT Option B+. Implementing these guidelines
should make it possible to eliminate mother to child transmission (MTCT) of HIV and
improve long-term maternal and infant outcomes. The present article summarises the key
recommendations of the 2015 guidelines and highlights current gaps that hinder optimal
implementation; these include late antenatal booking (as a result of poor staff attitudes towards
‘early bookers’ and foreigners, unsuitable clinic hours, lack of transport to facilities, quota
systems being applied to antenatal clients and clinic staff shortages); poor compliance with
rapid HIV testing protocols; weak referral systems with inadequate follow-up; inadequate
numbers of laboratory staff to handle HIV-related monitoring procedures and return of results
to the correct facility; and inadequate supply chain management, leading to interrupted
supplies of antiretroviral drugs. Additionally, recommendations are proposed on how to
address these gaps. There is a need to evaluate the implementation of the 2015 guidelines and
proactively communicate with ground-level implementers to identify operational bottlenecks,
test solutions to these bottlenecks, and develop realistic implementation plans.
