Framework to Improve the Utilization of EMTCT Services among Pregnant and Lactating Women in Gauteng Province, South Africa

The use of Elimination of Mother-to-Child Transmission services plays an important role in public health because it helps to prevent HIV transmission from mothers to infants. Accessibility of these services remains a challenge, especially in countries with high prevalence rates. A framework to improve the use of EMTCT services is helpful to ensure that children born to women living with HIV remain HIV-negative. This study aimed to develop and validate a framework to improve the utilization of EMTCT services among pregnant and lactating women in Gauteng Province of South Africa.

Primary data were collected from 681 pregnant and lactating women utilizing EMTCT services in the City of Ekurhuleni at the selected facilities. The qualitative and quantitative data provided a deeper understanding of the barriers to EMTCT utilization and perceived strategies to improve its utilization.

The study revealed barriers that contributed to poor EMTCT utilization, which include, a lack of transport costs to the facility, staff attitude, long waiting times, gender-based violence, and denial of HIV status. To mitigate these barriers, the EMTCT framework was developed using the Health Belief Model and Build, Overcome, Explore, Minimize model, incorporating the Strengths, Weaknesses, Opportunities, and Threats (SWOT) findings.

The developed framework has clearly defined objectives, activities, responsibilities, and outcomes, which serve as practical tools for implementation. The proposed framework was validated through consultations with stakeholders and the Delphi technique. Experts and stakeholders participated in the process of validating and confirming the effectiveness of the developed framework to improve the utilization of EMTCT services in Gauteng Province. This study identified practical strategies such as health education, peer support, male involvement, and the use of the Treatment Navigation Model. The framework provides a clear, context-specific approach to strengthening health systems and getting closer to eliminating mother-to-child HIV transmission.

The study found that the utilization of EMTCT services by pregnant and lactating women's is heavily influenced by social and economic realities such as insufficient awareness, partner abuse, and financial reliance.