Grant: Travel Awards - Institute Community Support

Some pregnant women under PMTCT, a programme that has been successfully integrated and influenced other maternal and child health services at primary health care (PHC) in South Africa, are also diagnosed with gestational diabetes (GDM). GDM is glucose intolerance recognised for the first time during pregnancy. It increases risk for type 2 diabetes (T2D) for women and their babies. GDM is managed at tertiary level in South Africa but how GDM is managed among HIV infected women has not been studied. Integrating PMTCT with GDM screening and intervention in routine antenatal care (ANC) and postnatal care (PNC) could potentially reduce T2D. This study explored how the PMTCT integration experience in South Africa could bridge gaps in managing GDM and T2D for women and their exposed babies and assessed the possibility of integrating GDM and T2D prevention into the PMTCT cascade at PHC level. Mixed methods were used. PMTCT data of 2012-2017 for Western Cape province, complemented by analysis of policy documents on PMTCT and PNC were analysed along with semi-structured interviews from 10 national and local key informants, 9 clinic managers, nurses and midwives and 10 HIV-infected women diagnosed with GDM (N=29), in Cape Town. GDM and other main non-communicable diseases screenings were not adequately included in both ANC and PNC policies that emphasized only on HIV services. All participants underlined the importance of integrated PMTCT, through which women who tested positive reached 84064 (235% increase) between 2014-2017, while those who delivered under PMTCT increased by 13% and MTCT reduced by 16% between 2012-2017 in Western Cape. All women interviewed wanted their GDM screening and management through PMTCT services. Most of the key informants and clinic staff said that GDM and T2D integration at PHC level could be feasible and can improve experienced quality of care upon more staff recruitment, adequate training and managerial support and infrastructure expansion.