Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Rafael Pérez-Escamilla

Second Advisor

Sten Vermund

Abstract

In sub-Saharan Africa (SSA) where mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) continues to be an ongoing problem, scale up of prevention of mother-to-child transmission (PMTCT) services remains a priority. Between 2001 and 2012 globally, the 52% decline of new pediatric HIV infection was attributed to the expansion of PMTCT services. In December of 2021, the World Health Organization (WHO) announced that Botswana was certified as having attained the silver-tier status in the elimination of mother-to-child transmission of HIV, because it had successfully reduced the MTCT rate to less than 5%, had provided antenatal care (ANC) and antiretroviral therapy (ART) to over 90% of pregnant women, and met the threshold of < 500 HIV cases per 1000,000 live births. This was a significant achievement as Botswana was the first high-burden country to be certified as having achieved this milestone. Hence, Botswana’s journey towards elimination of MTCT can help inform and guide decisions surrounding PMTCT program implementation for other SSA countries. The South African province of KwaZulu-Natal may particularly benefit from such knowledge transfer as it has one of the highest prevalence of HIV in the world at 20.6%. The overall objective of this paper is to conduct a case study on Botswana’s PMTCT implementation efforts to identify lessons learned from Botswana’s success with its PMTCT implementation to improve PMTCT services in KwaZulu-Natal. The two primary aims were to: (1) conduct a scoping review to understand Botswana’s journey towards elimination of mother to child transmission of HIV and (2) to identify lessons learned from Botswana to apply to KwaZulu-Natal. The majority of selected papers about Botswana’s PMTCT programs emphasized the integration of PMTCT into the broader healthcare system, ANC attendance, HIV testing coverage, infant feeding practices for breastfeeding among HIV-positive women, and targeted counseling and educational outreach efforts. These strategies can be adapted and applied to regions such as KwaZulu-Natal to reduce the performance gap for PMTCT for especially adolescent and young women. Future research exploring the specific structural and cultural barriers to antenatal attendance and health literacy will be important in maximizing program effectiveness to ensure adherence to the cascade of care. Accurate empirical evidence on the impact of PMTCT integration will guide future evidence-based interventions to eliminate MTCT in KwaZulu-Natal.

Comments

This is an Open Access Thesis.

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