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The Prevention-of-Mother-To-Child Transmission (PMTCT) program was introduced to prevent vertical transmission of HIV from a mother to her infant through pregnancy, labor, and breastfeeding. Therefore, it is critical for the program to be accessible in primary health care facilities across the globe to increase treatment uptake and to eliminate child and maternal mortality rates caused by HIV infections. However, barriers are still being experienced by some nurses while implementing PMTCT around Moretele sub-district in the North West Province (NWP). Hence, this qualitative study explored and described the factors influencing the implementation of PMTCT. A qualitative, exploratory-descriptive design was followed. Ten participants were selected purposively, and each participant was interviewed individually using WhatsApp video calling. All participants were made aware of their voices being recorded; data saturation was reached on the eighth participant as no new information evolved. Data were analyzed using Tesch’s method of qualitative data analysis. The findings revealed that factors that influenced PMTCT implementation were due to patient, management, and staff-related factors. Moreover, these factors impacted the provision of effective patient care. The findings of this study show that much still needs to be done to achieve and sustain the PMTCT implementation goal. Therefore, the training of nurses should be of paramount importance. They should be provided and equipped with the necessary resources, support, and encouragement to offer and ensure quality health care. Furthermore, the government should ensure that policies and guidelines are regularly monitored and evaluated.
A qualitative, exploratory-descriptive research design was used. This design was chosen to understand and investigate the in-depth concern regarding factors influencing PMTCT from the nurses’ perspective. 17 The context of this study is the Moretele sub-district in North West Province (NWP), South Africa (SA). Moretele sub-district has 2 Community Health Centers (CHC) operating 24 hours with 6 others but not CHCs and 13 Primary Health Care (PHC) facilities operating 5 days a week and 3 operating 7 days a week. These facilities are all based in rural areas. Moretele sub-district consists of 116 professional nurses of different professional qualifications, enabling them to provide good quality health care services for the community.18,19 The study population included all midwives, both males, and females who were knowledgeable about the factors influencing PMTCT in the Moretele sub-district of NWP. These midwives were willing to participate in the study as they signed an informed consent coordinated by a mediator. A non-probability, purposive sampling technique was used to select midwives who met the inclusion criteria. The mediator chose these participants based on the set inclusion criteria. The mediator followed a non-probability purposive sampling technique to determine the midwives responsible for PMTCT in the Moretele sub-district of NWP. Furthermore, these midwives were purposively selected as they were knowledgeable about the PMTCT program, particularly its implementation in the Moretele sub-district of NWP. The mediator selected the participants based on the following selection criteria. Thus, the participant should be a: professional midwife registered with the South African Nursing Council (SANC), working in the CHC facility, knowledgeable about PMTCT and the implementation thereof, and willing to consent for participation in the study. And the midwives would have access to WhatsApp video calling. Appointments were made telephonically with the research participants who were selected before data were collected to outline the purpose of the research. Semi-structured individual interviews were conducted in English using WhatsApp video calling, and participants were not subject to respond in 1 language. They were allowed to respond in a language of choice which enabled them to express their views succinctly. The interviews lasted from 30 to 60 minutes, and the participants were made aware of an audiotape being used during the interview and taking field notes. The researchers sought consent from the participants as an agreement to participate in the research. The researchers used probing questions as guidance for clarity during the interviews,20,21 Data were analyzed using Tesch’s method of qualitative data analysis. Organizing, preparing, and interpreting data for analysis was done by listening to the audiotape, transcribing interviews, translating interviews in native languages, typing field notes, and arranging data into different themes to give the research meaning and understand the topic. 17 After that, the results were compared with the recorded and transcribed data through the help of a co-coder for data verification and reliability. 20 The 4 elements of trustworthiness in qualitative research are credibility, dependability, confirmability, and transferability. 20 Increasing the study’s credibility was achieved by spending more time with participants in individual interviews for about 30 to 60 minutes until saturation was reached. Afterwards, we transcribed the recordings and shared interpretations with the participants to ensure they had been adequately and accurately captured. By maintaining an audit trail, which includes copies of notes, transcripts, and recorded data for future reference, participants were provided with researchers’ personal information for contact or explanation at any time. In order to enhance the validity of the PMTCT interview guide and interviewing skills, a pilot study was conducted with 3 nurses from another part of the NW province that were trained in PMTCT. This study does not present the results of the pilot. In an effort to refine study methods, we conducted a pilot study in another district with PMTCT nurses. In order to reach a consensus on the study methods and phrasing of the research question, 3 consecutive discussions were held with an independent co-coder. In order to enhance transferability, non-probability purposive sampling methods were used to collect data from PNs trained on PMTCT. Ethical approval was obtained from the North-West University Research Ethics Committee. Access to participants was granted through the North West Department of Health and the clinic sub-district Manager. The participants were assured that their identities would not be compromised as all recordings were kept in a locked safe, where only the researcher and supervisor, as well as the co-coder, had access to data verifications. 21
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