Stakeholders’ experiences in implementation of rapid changes to the South African prevention of mother-to-child transmission programme

BACKGROUND: South Africa’s prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) programme has undergone rapid changes in the last two decades. Initially, the provision of single antiretroviral therapy was based on eligibility criteria in the year 2001, which later changed to combination therapy. This was aimed at preventing mother-to-child transmission of HIV. Since 2015, all pregnant women were eligible for antiretroviral treatment regardless of their CD4 count. Although significant strides were made to reduce mother-to-child transmission of HIV, increased efforts are required to meet UNAIDS targets, World Health Organization (WHO) elimination framework goals and sustainable development goals to eliminate new HIV infections in children and ending the HIV epidemic by 2030. AIM: The aim of the study was to explore healthcare workers’ experiences and patient perceptions of the implementation of rapid changes to the PMTCT programme in four public healthcare facilities. SETTING: The study was conducted in the four public healthcare facilities within the two highly HIV-burdened districts of iLembe and eThekwini in KwaZulu-Natal province, South Africa. METHODS: This study used a qualitative, exploratory, descriptive study design using interviews and focus group discussions. Participants were selected using purposive sampling. Following verbatim transcription of the data, thematic data analysis was used through data reduction and data display and the emergence of four themes. RESULTS: A total of 61 stakeholders were interviewed. Four major themes emerged: (1) impact of poor health system design, (2) impact of poor communication of changes, (3) contextual factors affecting innovation in healthcare and (4) skill deficit in change management and forward planning. CONCLUSION: A healthcare system more responsive to the experiences of healthcare workers and pregnant women is required to effectively implement changes in priority programmes.