Table 5. Pregnancy-Related Health Systems Factors.

PREGNANCY-RELATED HEALTH SYSTEMS BARRIERS AND ENABLERS
Challenge of coordinating HIV care for women with their movement into ANC, through the delivery and post-partum phases of care, and back into general adult primary care
Loss of focus on pregnant women's health needs in the context of PMTCT programs' focus on preventing vertical transmission
The particular blind spot of the postpartum period, when women are transitioning out of ANC and PMTCT care but not are effectively linked to ongoing primary or HIV care
Health services that are not set up to respond to the unique health and social needs of pregnant women (e.g. not sitting and waiting all day to be seen, not being viewed (by selves and others) as ‘sick enough’ to warrant focused attention, need for movement across facilities during and after pregnancy to access social support, difficulty in coordinating both ANC and HIV care visits, if separate)
Poor knowledge and training among healthcare workers about the importance of maternal ART, maternal ART protocols and maternal ART referral procedures
Time-bound nature of pregnancy not sufficiently accounted for in some ART protocols that required lengthy assessment and drug readiness training before initiation