Abstract
Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well described. We explored these factors within an enhanced sub-cohort of the East Africa International Epidemiology Databases to Evaluate AIDS Consortium. From 2018-2019, a purposeful sample of PPHIV ≥18 years of age were recruited from five maternal and child health clinics providing integrated PMTCT services in Kenya. Women retained in care were recruited at the facility; women who had become LTFU (last visit >90 days) were recruited through community tracking. Interview transcripts were analyzed thematically using a social-ecological framework. Forty-one PPHIV were interviewed. The median age was 27 years, 71% were pregnant, and 39% had become LTFU. In the individual domain, prior PMTCT experience and desires to safeguard infants' health enhanced retention but were offset by perceived lack of value in PMTCT services following infants' immunizations. In the peer/family domain, male-partner financial and motivational support enhanced retention. In the community/society domain, some women perceived social pressure to attend clinic while others perceived pressure to utilize traditional birth attendants. In the healthcare environment, long queues and negative provider attitudes were prominent barriers. HIV-related stigma and fear of disclosure crossed multiple domains, particularly for LTFU women, and were driven by perceptions of HIV as a fatal disease and fear of partner abandonment and abuse. Both retained and LTFU women perceived that integrated HIV services increased the risk of disclosure. Retention was influenced by multiple factors for PPHIV. Stigma and fear of disclosure were prominent barriers for LTFU women. Multicomponent interventions and refining the structure and efficiency of PMTCT services may enhance retention for PPHIV.
Highlights
Retention in care is a major challenge in the prevention of mother-to-child transmission of HIV (PMTCT) continuum in sub-Saharan Africa
Studies across the sub-continent have shown that nearly a third of women initiating antiretroviral treatment (ART) during pregnancy become lost to follow-up (LTFU) during the subsequent year [1,2,3,4,5,6]
A detailed understanding of the factors that influence retention is needed to inform the development of interventions to improve PMTCT outcomes for pregnant and postpartum women living with HIV (PPHIV)
Summary
Retention in care is a major challenge in the prevention of mother-to-child transmission of HIV (PMTCT) continuum in sub-Saharan Africa. Multiple studies have examined retention in the PMTCT continuum in sub-Saharan Africa These studies have identified a variety of barriers to retention, including younger age, HIV-related stigma and fear of disclosure, low socioeconomic status, inadequate social support, and negative healthcare worker attitude [1, 10,11,12,13,14,15,16,17,18,19,20,21,22]. Such barriers include heightened stigma and fear of public disclosure at clinics providing care to women living with and without HIV, and increased provider workload increasing patient wait times and impacting patient-provider relationships [30]
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