In search of reason: prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa

The 2008 scale-up of South African public sector prevention of mother-to-child transmission (PMTCT) to an AZT/sdNVP regimen led to significant reductions in vertical HIV transmission, yet incident paediatric infections continue. The objectives of this study were to 1) identify mothers of newly HIV-infected infants, and assess whether they received per-guideline PMTCT antiretroviral (ARV) regimens, and 2) qualitatively explore contextual factors contributing to these prescription failures and MTCT risk. Eligible women included birthmothers of HIV-infected infants in Soweto. Participants (n=45) first completed a questionnaire, and then a focus group or structured interview. Through triangulation of data, it was determined that 29 mother-infant pairs (64%) did not receive per-guideline PMTCT ARV regimens. Identified issues of importance include preterm birth, delayed antenatal care attendance, operational difficulties implementing PMTCT, and HIV-related stigma. While improved PMTCT regimens are available, social and structural factors must be addressed to ensure access to and uptake of prevention services.