Abstract:
Background: Integration of HIV into RMNCH (reproductive, maternal, newborn and child health) services is an
important process addressing the disproportionate burden of HIV among mothers and children in sub-Saharan
Africa. We assess the structural inputs and processes of care that support HIV testing and counselling in routine
antenatal care to understand supply-side dynamics critical to scaling up further integration of HIV into RMNCH
services prior to recent changes in HIV policy in Tanzania.
Methods: This study, as a part of a maternal and newborn health program evaluation in Morogoro Region, Tanzania,
drew from an assessment of health centers with 18 facility checklists, 65 quantitative and 57 qualitative provider
interviews, and 203 antenatal care observations. Descriptive analyses were performed with quantitative data using
Stata 12.0, and qualitative data were analyzed thematically with data managed by Atlas.ti.
Results: Limitations in structural inputs, such as infrastructure, supplies, and staffing, constrain the potential for integration
of HIV testing and counselling into routine antenatal care services. While assessment of infrastructure, including waiting
areas, appeared adequate, long queues and small rooms made private and confidential HIV testing and counselling
difficult for individual women. Unreliable stocks of HIV test kits, essential medicines, and infection prevention equipment
also had implications for provider-patient relationships, with reported decreases in women’s care seeking at health
centers. In addition, low staffing levels were reported to increase workloads and lower motivation for health workers.
Despite adequate knowledge of counselling messages, antenatal counselling sessions were brief with incomplete
messages conveyed to pregnant women. In addition, coping mechanisms, such as scheduling of clinical activities on
different days, limited service availability.
Conclusion: Antenatal care is a strategic entry point for the delivery of critical tests and counselling messages and the
framing of patient-provider relations, which together underpin care seeking for the remaining continuum of care. Supplyside
deficiencies in structural inputs and processes of delivering HIV testing and counselling during antenatal care indicate
critical shortcomings in the quality of care provided. These must be addressed if integrating HIV testing and counselling
into antenatal care is to result in improved maternal and newborn health outcomes.
