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Table 3 Responses to weak areas identified during the assessment from group work undertaken with the assessment teams and key district management.

From: Improving the coverage of the PMTCT programme through a participatory quality improvement intervention in South Africa

Reasons for the low coverage of nevirapine to women and infants Reasons for the low coverage of CD4 testing amongst HIV positive women Reasons for the low coverage of PCR testing amongst HIV exposed infants at 6 weeks
Client factors:
clients not clear about when to take nevirapine.
unbooked patients/late booking
Health system factors:
lack of training of nursing staff
lack of privacy in labour wards thus difficult to ask about HIV status
nurses not checking HIV status on medical records
lack of ownership of the PMTCT programme by staff
poor recording of nevirapine doses during ANC/labour.
nevirapine not available or locked in a cupboard
Health system factors:
shortage of staff
unclear roles & responsibilities
poor recording of HIV status on antenatal records
some facilities only 1 person in charge of HIV and responsible for all CD4 testing
lack of staff knowledge and motivation
lack of clarity on the PMTCT protocol
low confidence in interpretation of policies/protocols
Client factors:
mothers fear of disclosing status or of knowing child's status
infants brought to clinic by nanny or grandmothers which results in consent issues for testing
mothers not being adequately informed
Health system factors:
no tracing system for defaulters
staff shortages
whose role is it? registered nurse/enrolled nurse
too few staff trained to do PCR -- seen as complicated procedure
coding system on RTHC difficult to understand
poor/no recording on RTHC