Abstract:
The prevention of mother-to-child HIV transmission (PMTCT) is a complex challenge in heavily affected and
resource-limited settings such as South Africa. Management of PMTCT requires a cascade of interventions that
need to be addressed to effectively decrease the risk of HIV transmission to infants. This PMTCT cascade
includes incremental components that can be shaped and influenced by the patient provider relationship. The
relationship that a pregnant woman has with her care providers may possibly affect decisions that she makes
concerning her antenatal care and may, in turn, influence the quality of the care provided. A patient provider
relationship scale (PPRS) was developed in Pretoria, South Africa with two aims: first, to quantify the patient
provider relationship in an antenatal population in a resource-limited setting and provide preliminary evidence of
its reliability and validity; and second, to determine whether the patient provider relationship has an effect on
PMTCT. The instrument was administrated in a cross-sectional pilot study to a group of women at discharge
after delivery (n 192) at two major hospitals in South West Tshwane. Statistical analysis of the instrument
showed high reliability (a 0.91) and preliminary evidence of its validity including significant associations with
participants’ attitudes regarding the functioning of the clinics and a single statement (the clinic staff ‘‘know me as
a person,’’ R 0.47, pB0.001) that has been shown previously to have a significant association with adherence to
antiretroviral treatment. For HIV-positive participants, the PPRS was significantly associated with statements
related to important components of the PMTCT cascade. In addition, those with substantially inadequate
antenatal care (52 visits) and those who did not initiate highly active antiretroviral therapy, although eligible,
had significantly poorer PPRS scores. The PPRS is a potentially useful, context-appropriate instrument that
could have an important role in future research focused on improving PMTCT and decreasing the risk of HIV
infection in children.
