INT J TUBERC LUNG DIS 17(10):1285–1290 © 2013 The Union http://dx.doi.org/10.5588/ijtld.12.0068 Integration of tuberculosis and prevention of mother-to-child transmission of HIV programmes in South Africa J. Uwimana,* † D. Jackson* * School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa; † School of Public Health, National University of Rwanda, Kigali, Rwanda Correspondence to: Jeannine Uwimana, School of Public Health, University of the Western Cape, Modderdam Road, Cape Town 7535, South Africa. Tel: (+27) 21 959 9391. Fax: (+27) 21 959 2872. e-mail: juwimana@uwc.ac.za Article submitted 26 January 2012. Final version accepted 29 April 2013. SETTING: One of the rural districts in KwaZulu-Natal Province, the epicentre of the human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics in South Africa. OBJECTIVES: To assess the integration of TB services into the prevention of mother-to-child transmission of HIV (PMTCT) programme and identify barriers to the integration of services. DESIGN: Cross-sectional survey using exit interviews with pregnant women attending 10 antenatal care (ANC) clinics. Review of ANC PMTCT facility routine data. Qualitative interviews with 26 key informants on barri- ers to integration of TB-PMTCT services. RESULTS: Of 150 women interviewed, 112 (75%) re- ported being educated on TB symptoms on the day of their visit; 56% were screened for TB symptoms and 27% were suspected to have TB; 26 (17%) women were HIV-positive and 2 (8%) were co-infected with TB. There was no record of provision of isoniazid prophy- laxis for PMTCT clients with latent tuberculous infec- tion. The predominant barriers to the integration of TB- PMTCT services included lack of skilled providers and their supervision, the physical layout of the TB-PMTCT services and the service delivery mechanisms. CONCLUSION: The integration of TB prevention and care into the PMTCT programme was inadequate. Inte- gration of TB services into the ANC PMTCT pro- gramme will require strong leadership to address barri- ers such as training gaps, lack of supervision and service delivery mechanisms. KEY WORDS: tuberculosis; antenatal care; integration barriers TUBERCULOSIS (TB) kills more women than all causes of maternal mortality combined, and has con- tributed to maternal and infant mortality in high hu- man immunodeficiency virus (HIV) settings. 1 While globally women account for almost 36% of all smear- positive cases, 2 in South Africa they account for more than 45%. 3,4 Active TB disease in pregnant women is a risk for significant perinatal morbidity, mortality and vertical transfer of Mycobacterium tuberculosis to their babies. 1,5 Women have a higher rate of pro- gression from infection to TB disease and higher case fatality than men, particularly those in the reproduc- tive age (15–49 years). 6,7 Studies have shown that 15–16% of mothers with TB transmit the infection to their infants within the first 3 weeks of life. 1,5 Early identification of TB among pregnant women through TB symptom screening, tracing of TB contacts and provision of isoniazid preventive therapy (IPT) for la- tent tuberculous infection (LTBI) for HIV pregnant women are thus vital interventions to enhance ma- ternal and child health care (MCH) and TB control among this population. South Africa is one of the sub-Saharan African countries most heavily affected by the dual epidemic of TB and HIV. It has been ranked as the third high- est TB burden country, 2 with the highest rate of TB- HIV co-infection. Pillay et al., in their prospective study on pregnant women infected with HIV-1 in Durban, KwaZulu-Natal (KZN), highlighted that the risk for transmission of TB from mother to newborn was 15% among HIV-positive pregnant women. 4 A study in Soweto, Johannesburg, on the feasibil- ity of integrating TB case finding into prevention of mother-to-child transmission of HIV (PMTCT) ser- vices indicated that, based on TB symptom screening, 32% of pregnant women were TB suspects, and that TB prevalence among pregnant women with HIV was 210 per 100 000 population. 8 These findings sug- gest that TB prevention and control should be an in- tegral part of antenatal care (ANC) PMTCT services to mitigate the impact of TB on mothers and their ba- bies and aid in reaching the Millennium Development Goals (MDGs). In the light of this context, we investigated the level of integration of TB prevention and care into ANC PMTCT services and identified barriers re- lated to the integration of TB and ANC PMTCT programmes. SUMMARY