Administering human immunodeficiency virus post-exposure prophylaxis: challenges experienced by mothers in Lusaka, Zambia.

Mildred Lusaka,Talitha Crowley

doi:10.4102/sajhivmed.v22i1.1183

Abstract

BackgroundMothers living with human immunodeficiency virus (HIV) should be guided to practise safe childbirth, provide appropriate infant feeding, return infants for repeat HIV testing and administer for the required period, protective antiretroviral (ARV) medication (post-exposure prophylaxis [PEP]) to their infants. Although several studies have explored challenges related to the prevention of mother-to-child transmission (PMTCT), no studies were found that focused specifically on the mother and PEP.ObjectivesTo explore and understand the challenges experienced by mothers in Lusaka, Zambia, whilst providing their children with PEP.MethodsThis study utilised a qualitative methodology and a descriptive design. Fifteen semi-structured individual interviews were conducted with mothers who gave PEP to their infants. Study evaluation made use of Creswell’s six steps of data analysis.ResultsWomen experienced numerous challenges. Challenges of an individual and social nature included ‘negative’ emotions, misconceptions and a lack of understanding of PEP. Post-exposure prophylaxis was sometimes burdensome and partner involvement often limited. Cultural, religious practices and stigma deterred some women from continuing PEP. Healthcare challenges included time-consuming appointments and protracted waiting periods. Clinic organisation was often inefficient and complicated by stock-outs of essential medication such as nevirapine. Healthcare workers were at times stigmatising towards mothers living with HIV and their infants. The counselling support provided by the healthcare workers was felt to be inadequate in the face of the burden of PEP.ConclusionPost-exposure prophylaxis as part of the PMTCT programme is key to eliminating mother-to-child transmission of HIV. Postnatal support for women administering PEP to their children can be enhanced through counselling that is person- and family-centred is culturally sensitive and offers differentiated services that include PEP, integrated mother-and-child healthcare and access to support groups.

Highlights

90% of new human immunodeficiency virus (HIV) infections of children and most acquired immunodeficiency syndrome (AIDS)-related paediatric deaths occur in Africa.[1,2] In 2019, 150 000 children globally were ‘newly infected’ with HIV.[1]
Social and healthcare system challenges were identified that were related to the administration of post-exposure prophylaxis (PEP) to infants born to women (mothers) living with HIV (WLWH)
The healthcare system itself was often a challenge to overcome rather than a supportive asset to these young mothers.[24,26,27]. These findings indicate the need for person or family-centred counselling that focuses on the evaluation of and solution to individual barriers and enablers of PEP

Summary

Introduction

90% of new human immunodeficiency virus (HIV) infections of children and most acquired immunodeficiency syndrome (AIDS)-related paediatric deaths occur in Africa.[1,2] In 2019, 150 000 children globally were ‘newly infected’ with HIV.[1] Most acquire HIV infection vertically, that is, from their mothers. The UNAIDS target of eliminating mother-to-child transmission in Africa by 2030 is still a long way off.[2] Numerous randomised clinical trials (RCTs) have confirmed the efficacy of antiretroviral (ARV) drugs both as treatment and as prevention of HIV.[3] The widespread and consistent use of ARVs in prevention, antiretroviral treatment (ART) and infant–mother post-exposure prophylaxis (PEP) provides Africa with its most accessible means to end HIV-related infant morbidity and mortality.[1,4]. Several studies have explored challenges related to the prevention of mother-to-child transmission (PMTCT), no studies were found that focused on the mother and PEP

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