South Africa has reported challenges in retaining women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs postnatally. Due to the success of PMTCT in the antenatal period, proportionally more infant transmissions now occur after delivery. The Médecins sans Frontières (MSF) Postnatal Club (PNC) model, allows for integrated postnatal care and support. Anova Health Institute implemented the model in primary health facilities in Johannesburg as part of a planned national scale-up. We aimed to assess the implementation of these PNCs.
We used the RE-AIM (Reach, Adoption, Implementation, Maintenance) framework to develop interview guides to explore factors influencing implementation. In-depth interviews were conducted with 15 PNC staff, both clinicians and lay counsellors, conveniently sampled from 9 facilities in Johannesburg. Data was analysed using the RE-AIM framework.
PNC were perceived to have many benefits to postnatal clients and their infants: providers reported reduced waiting times, reduced number of clinic visits and provided patients with a space to form cohesive group dynamics thereby contributing to retention and adherence to ART. However, it was found that lacking resources (e.g., space, medical equipment, staff) negatively impacted reach, implementation and sustainability. At times the PNC model was altered to accommodate the availability of resources (e.g., counselling mothers individually). Additionally, providers expressed concerns about lack of stakeholder adoption and emphasized the importance of involvement of facility leadership for successful integration of the model into routine primary healthcare.
Our study found incomplete implementation of PNC in most of the participating facilities attributed to lacking resources and stakeholder buy-in. This underscores the need for increased support at management level to ensure sustainability. Effective collaboration would allow better use of existing resources. Further studies are needed to evaluate whether all components of the model need to be implemented fully to ensure optimal outcomes.