Implementation of a programme for the prevention of mother-to-child transmission of HIV in a Ugandan hospital over five years: challenges, improvements and lessons learned.

To identify factors that may limit acceptance of HIV testing and enrolment in the programmes for the prevention of mother-to-child-transmission of HIV, we retrospectively assessed the performance of the service at St Francis Hospital, Nsambya in Kampala. Over five years, a total of 26,556 pregnant women were offered voluntary counselling and confidential HIV testing and, if HIV positive, enrolment in the programme. Acceptance of the HIV test increased in the last two years (from 72.7% in 2001-2002 to 79.9% in 2003-2004). Enrolment in the programme increased over time and was greater among older (64% in women older than 30 years and 44.8% in those aged less than 20 years) and highly educated women. HIV prevalence was associated with age and inversely associated with the level of education. The need for specific personnel for counselling, male partners' involvement and availability of antiretroviral drugs for those who needed treatment were identified as factors possibly affecting implementation.