Midwives’ views on implementation of antiretroviral clinical guidelines for the prevention of HIV in a private hospital

Background: South Africa has made considerable progress in HIV and AIDS management, particularly in vertical transmission prevention (VTP). The 2023 national HIV guidelines, which includes provision for pregnant and breastfeeding women, mark an important advancement. However, implementation in the private healthcare sector remains uncertain. The effective application of antiretroviral therapy (ART) guidelines in maternity wards within private hospitals is essential to prevent vertical transmission of HIV. Aim: This study explored midwives’ perspectives on the implementation of ART clinical guidelines for preventing vertical HIV transmission in maternity wards within a private hospital in Gauteng province. Setting: The study was conducted in a maternity ward of a private hospital in the Tshwane District, Gauteng, South Africa. Methods: A qualitative, exploratory, descriptive design was used. Thirteen purposively selected midwives participated in in-depth, semi-structured interviews, which were audio-recorded with consent, transcribed verbatim and thematically analysed to develop themes. Results: Four themes emerged: (1) Lack of standardised practice in implementing VTP guidelines; (2) Ethical and confidentiality challenges; (3) Limited role of midwives in VTP management; and (4) Strategies to enhance implementation and use of ART clinical guidelines in private hospitals. Conclusion: The findings highlight challenges in implementing ART guidelines in private maternity settings and emphasise the need for stronger integration of national HIV guidelines through training, policy alignment and institutional support to improve maternal and neonatal outcomes. Contribution: The study presents recommendations for strengthening the role of private hospitals in reducing vertical HIV transmission and supporting HIV and AIDS elimination goals.