Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry

HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. Eligibility criteria for antiretroviral therapy (ART) in pregnant women were revised in 2010 to enhance ART coverage. This study documented women’s experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT) programmes in the Eastern Cape and Gauteng provinces. In-depth interviews identified considerable weaknesses within operational HIV service delivery. Individual factors undermining access encompassed psychosocial concerns and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate. The study concludes that a single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays often signalled wholesale denial of prevention and treatment. There is great scope for health systems’ reforms to address these constraints and weaknesses.