Option B+ Program for the Prevention of Vertical Transmission of HIV: A Case Study in Johannesburg, South Africa
Bibliographic record
Abstract
South Africa’s National Department of Health adopted WHO’s 2013 consolidated guidelines on ARVs for HIV treatment and prevention in 2015, including changes for Prevention from Mother-to-Child Transmission (PMTCT) through Option B+, aimed to reduce the HIV prevalence rate amongst women by placing them on lifelong treatment, irrespective of their CD4 count. As a result, these guidelines were implemented for the PMTCT program at Rahima Moosa Hospital. Little is known about the impact of these guidelines on the work of healthcare workers (HCWs) and no research had focused on how these changes have affected adherence for the patients. The objectives of this study is to; (1) explore the impact of the Option B+ PMTCT program on work of HCWs, and (2) understand these patient views and experiences with lifelong ART to better manage the program. Qualitative semi-structured interviews with a phenomenological approach was used. Data collection was conducted at the ANC/PNC facilities, OBGYN and Department of Pediatrics at RMMCH in Johannesburg. A qualitative approach was used with convenience sampling. Results demonstrated that work had become difficult to manage for all HCWs because of the (1) need for strengthening indicators to decrease loss-to-follow-up; (2) inconsistency in delivery of counseling & support services and; (3) lack of compassion and understanding by service providers. The difficult healthcare environment had affected overall views and experiences of these women going on lifelong ART. All patient participants (n=55) responded they chose to take the FDC pill to protect the baby’s health and believed lifelong ART could be stopped after delivery, unaware of the long-term benefits. In conclusion, the perspective of patients and HCWs in policy implementation; uptake and adherence are key indicators in informing whether the program is being adapted into healthcare facilities effectively. Extensive research needs to focus on long-term scalability and sustainability. Future evaluations need to address how interdisciplinary collaboration within healthcare facilities can improve program management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".