Integration of tuberculosis and prevention of mother-to-child transmission of HIV programmes in South Africa

SETTING: One of the rural districts in KwaZulu-Natal Province, the epicentre of the human irnmunodeficiency virus (HIV) and tuberculosis (TB) epidemics in South Africa. OBJECTIVES: To assess the integration of TB services into the prevention of mother-to-child transmission of HTV (PMTCT) programme and identify barriers to the integration of services. design: Cross-sectional survey using exit interviews with pregnant women attending 10 antenatal care (ANC) clinics. Review of ANC PMTCT facility routine data. Qualitative interviews with 26 key informants on barriers to integration of TB-PMTCT services. RESULTS: Of 150 women interviewed, 112 (75%) reported being educated on TB symptoms on the day of their visit; 56% were screened for TB symptoms and 27% were suspected to have TB; 26 (17%) women were HIV-positive and 2 (8%) were co-infected with TB. There was no record of provision of isoniazid prophylaxis for PMTCT clients with latent tuberculous infection. The predominant barriers to the integration of TB-PMTCT services included lack of skilled providers and their supervision, the physical layout of the TB-PMTCT services and the service delivery mechanisms. CONCLUSION: The integration of TB prevention and care into the PMTCT programme was inadequate. Integration of TB services into the ANC PMTCT programme will require strong leadership to address barriers such as training gaps, lack of supervision and service delivery mechanisms.