Key Factors in the Successful Implementation of a Model PMTCT Program in Johannesburg, South Africa

The program's objective was to retain both mother and baby in care for 18 months after delivery, ensuring HIV status and developmental milestones were monitored throughout the breastfeeding period. The program began in June 2014 and expanded antenatal and postnatal services from 10 weeks post-partum up to 18 months by September 2014. Support groups and health education talks covering family planning, fatherly involvement, and breastfeeding technique were integrated into antenatal and postnatal care. Maternal treatment for HIV and repeat tests for HIV-negative mothers were provided during infants' postnatal care, HIV testing, and vaccination visits, treating the mother-infant pair as a dyad. A mother-infant registry was maintained to monitor antenatal and postnatal visits, and mothers were traced if they or their infants defaulted from the program. The expansion of services resulted in an increase in antenatal and postnatal visits from 643 in October 2013 to 1253 in October 2014. A total of 1510 mothers were registered in the system in the first 4 months, with 25% of them being HIV-positive. The program also encouraged partner involvement, with 74.1% of mothers receiving letters inviting their partners to accompany them to the clinic. Of these partners, 82% had an unknown HIV status. The FRESH Start program's holistic approach not only treats but also empowers vulnerable mothers and children at high risk of HIV infection. The comprehensive services offered by the program must be further evaluated to quantify the effect on improved clinical outcomes and promoting adherence to scheduled visits and medication regimes. The program's success in retaining mothers and babies in care for 18 months after delivery is a significant achievement, ensuring that HIV status and developmental milestones are monitored throughout the breastfeeding period.