Implementation of the Prevention of Mother-to-Child Transmission (PMTCT) Program in the Northern Cape, South Africa.

Background: South Africa's Prevention of Mother-to-Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) program has been implemented for over ten years. This has led to a considerable reduction in mother-to-child transmissions. In 2010, the Northern Cape Province had a 1.4% transmission rate, being the lowest in the country.

Objective: To describe the implementation of the PMTCT program in the Frances Baard district, Northern Cape Province; South Africa and identify factors that may influence the effectiveness of this program.

Method: 100 Mother-child pairs from four clinics participated in this cross-sectional study. Information was collected on socio demographics, antenatal clinic attendance, feeding counseling, knowledge and practices, CD4 cell count and HIV stage, antiretroviral treatment (ART) initiation/adherence and partner involvement.

Results: Almost 25% of mothers first attended an antenatal clinic during their third trimester, out of them, 52.2% were tested for HIV infection for the first time. Most of the mothers received counseling on feeding practices during antenatal visits (97%), after labor (64%) and during post natal visits (84%). Most mothers knew the definition (77%) and recommended duration (76%) of exclusive breastfeeding and the dangers of defaulting ART when breastfeeding (75%), but only two mothers knew the risk of mixed feeding. Fifteen mothers were pressured to stop breastfeeding by healthcare professionals before 12 months. More than half (52%) of the mothers started ART during their last pregnancy, among them, 50% only started treatment after 14 weeks of gestation. The children who received ART, 13.7% defaulted their treatment for one day or more. All three HIV infected children's mothers defaulted their own ART while breastfeeding.

Conclusion: The PMTCT program is implemented according to the national policy in this district. Earlier ART initiation and improved compliance, education of healthcare workers, more focused counseling sessions and improving community awareness of early antenatal visits may improve effectiveness of this program.