Abstract
ABSTRACT Few studies have explored the relationship between early infant diagnosis (EID) of HIV and mothers’ engagement in care under Option B+. We conducted in-depth interviews with 20 women who initiated antiretroviral therapy (ART) under Option B+ in rural South Africa to explore the interactions between EID and maternal care engagement. Drawing on practice theory, we identified themes relating to Option B+ care engagement and EID. Women’s practice of engagement with HIV care shaped their decision-making around EID. Mothers who disengaged from care during pregnancy were less inclined to utilise EID as they lacked information about its availability and benefits. For some mothers, tensions between wanting to breastfeed and perceptions that it could facilitate transmission led to repeated utilisation of EID as reassurance that the child remained negative. Some mothers used their child’s negative result as a proxy for their status, subsequently disengaging from care. For some participants, an HIV diagnosis of their infant and the subsequent double burden of treatment visits for themselves and their infant, contributed to their disengagement. Women’s care-seeking practices for themselves and their infants work in a symbiotic ecosystem and should be viewed interdependently to tailor interventions to improve EID uptake and Option B+ care engagement.
Highlights
By 2015, Option B+, which involves initiating all HIV positive pregnant women on antiretroviral therapy (ART) regardless of immunological stage (WHO, 2015) and testing all exposed infants (UNAIDS, 2011) had been adopted as national policy for prevention of mother-to-child transmission of HIV (PMTCT) programmes in the majority of sub-Saharan African countries, including South Africa (South Africa: National Department of Health, 2015)
The qualitative sub-study presented here includes the in-depth interviews (IDIs) conducted with Option B+ women living with HIV (n = 20, 7 not engaged in care) who had given birth since 2015 and who resided in the area covered by the Agincourt health and demographic surveillance system (AHDSS) in rural Bushbuckridge, Mpumalanga province, north-eastern South Africa in 2017 (Kahn et al, 2012)
In this study with mothers living with HIV in north-eastern South Africa, we explored the interplay between mothers’ engagement in HIV care and early infant diagnosis (EID), highlighting its complexity and bi-directional nature (Figure 3)
Summary
By 2015, Option B+, which involves initiating all HIV positive pregnant women on antiretroviral therapy (ART) regardless of immunological stage (WHO, 2015) and testing all exposed infants (UNAIDS, 2011) had been adopted as national policy for prevention of mother-to-child transmission of HIV (PMTCT) programmes in the majority of sub-Saharan African countries, including South Africa (South Africa: National Department of Health, 2015). Option B+ has dramatically increased the number of pregnant women initiating ART, retention has been challenging, in the postnatal period and after breastfeeding cessation (Dzangare et al, 2016; Erlwanger et al, 2017; Knettel et al, 2017; Tenthani et al, 2014). For PMTCT programmes to be effective, mothers need to attend services to receive prophylaxis for new-borns, test their infants (early infant diagnosis (EID)) and for those who test positive, initiate them onto lifelong ART
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