Transitioning to the WHO 2010 PMTCT and infant feeding guidelines at the local level: Identifying and addressing operational challenges in Tanzania

In July 2010, the World Health Organization released new prevention of mother-to-child transmission (PMTCT) of HIV and infant feeding guidelines. Accordingly, the Tanzania Ministry of Health and Social Welfare (MOHSW) revised their national guidelines. Countrywide transitioning from the 2006 to the 2010 guidelines began in August 2011.

In August 2011, the USAID Health Care Improvement Project (HCI) in collaboration with Iringa Regional and Njombe District Health Management Teams conducted an assessment at three facilities transitioning to the 2010 guidelines in Njombe, Tanzania. Quality improvement methods were applied to identify and address operational setbacks and other transitional challenges.

Only 5%(5/91) of providers received training on the updated guidelines, which was inadequate for optimal service delivery. Late booking at antenatal care (ANC)—beyond 14 weeks gestation—delayed timely initiation of antiretrovirals (ARVs) as recommended in 2010 guidelines. Earlier ARV initiation led to more women qualifying for ARVs. Additional drug cabinets and supply management trainings were necessary to meet the increased demand. Mothers were confused about continuing breastfeeding after six months as opposed to six months of exclusive breastfeeding under the 2006 guidelines. Mothers were concerned about side effects when giving ARVs to exposed infants for the newly extended period.

The MOHSW should ensure registers, reporting forms, and providers are updated on the 2010 guidelines. Mobilize communities to support booking earlier at ANC, infant feeding, and adherence. Facility staff should use monthly data to identify gaps in services to improve care. Local solutions identified as best practices can guide transition in other districts and regions.