South African Health Center Doubles Number of Infants Tested for HIV in Six Months

The Letlhabile Community Health Center in Madibeng sub-district, North West Province, South Africa more than doubled polymerase chain reaction (PCR) testing of HIV exposed babies at six weeks in six months. By August 2010, the community health center tested 89% of babies, up from 42% in March 2010. This was a result of participation in the Leadership Development Program (LDP) led by Management Sciences for Health (MSH), through the US Agency for International Development (USAID)-funded Integrated Primary Health Care (IPHC) Project.

PCR testing detects the HIV virus whereas HIV rapid tests detect HIV antibodies. Because mothers pass HIV antibodies to their babies both in utero and through breast milk, the rapid test is not accurate before 18 months of age. By using PCR, health professionals can identify HIV-positive infants within weeks of birth, before they get sick.

The LDP program helped the Letlhabile Community Health Center address major challenges it was facing and helped the team focus on identifying one result they could achieve in six months.

As part of IPHC's commitment to strengthening health systems, the project identified that leadership and management skills at the district and sub management level needed strengthening. Managers play a crucial role in guiding organizations through planning, directing, monitoring, and managing resources. The LDP course, presented by IPHC, prepares health care managers to lead their staff and to face priority health challenges in complex health settings.

The team that participated in the LDP identified their mission as providing, in partnership with their stakeholders, an effective and efficient prevention of mother-to-child transmission (PMTCT) program. When the team met in March they noted that only 42% of infants born to HIV-positive mothers were tested for HIV at the six- week point. To improve the PMTCT program, the team decided they needed to increase PCR testing at the clinic to 80% within six months – the health center exceeded this goal.

In addition to increasing PCR testing at six weeks, the Madibeng sub-district team developed a comprehensive PMTCT register. This register consolidates information collected across different registers, such as the "blood book," the Pellargon (formula milk) register, HIV testing for mothers, and PCR tests for babies. A mother is now seen from early pregnancy and recorded in this register. She is given a unique reference number that is used for appointment booking, blood results, counselling, delivery, drugs, and other needs. The mother and baby are monitored in this register from early pregnancy to nine months post-delivery. This integrated and user-friendly register results in continuity of care for the patients and good working relationships between the clinics.

The success of this program can hopefully lead to its application elsewhere. "We want children to be HIV negative on the register, and if other health care managers see children are HIV negative, they will recommend the program to everyone," explained Ms. Poo, former Assistant Manager for Primary Health Care at Letlhabile Community Health Center and member of the extended LDP team.

The Madibeng sub-district team recommend that the PMTCT register be implemented at all facilities.

The Integrated Primary Health Care project is a collaborative effort of the National Department of Health, the provincial Departments of Health in the Eastern Cape, KwaZulu Natal, Limpopo, Mpumalanga, and North West provinces, and USAID.

The IPHC project supports 68 primary health care and community health centers, as well as 16 accredited antiretroviral sites. The IPHC project supports the government to improve access to child heath, reproductive health, and HIV & AIDS services by strengthening management systems at the district level, by using a supportive supervision system, and by improving the use of data for decision-making. Linkages between health facilities and the communities they serve are also promoted.


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