Abstract
IntroductionThere has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV.Objective and MethodsThis prospective cohort study of 100 HIV-positive women recruited within pregnancy-related services in a district hospital in Kenya employed quantitative methods to assess attrition between women testing HIV-positive in pregnancy-related services and accessing long-term HIV care and treatment services. Qualitative methods were used to explore barriers and facilitators to navigating these services.Structured questionnaires were administered to cohort participants at enrolment and 90+ days later. Participants’ medical records were monitored prospectively. Semi-structured qualitative interviews were carried out with a sub-set of 19 participants.FindingsOnly 53/100 (53%) women registered at an HIV clinic within 90 days of HIV diagnosis, of whom 27/53 (51%) had a CD4 count result in their file. 11/27 (41%) women were eligible for immediate antiretroviral therapy (ART); only 6/11 (55%) started ART during study follow-up. In multivariable logistic regression analysis, factors associated with registration at the HIV clinic within 90 days of HIV diagnosis were: having cared for someone with HIV (aOR:3.67(95%CI:1.22, 11.09)), not having to pay for transport to the hospital (aOR:2.73(95%CI:1.09, 6.84)), and having received enough information to decide to have an HIV test (aOR:3.61(95%CI:0.83, 15.71)). Qualitative data revealed multiple factors underlying high patient drop-out related to women’s social support networks (e.g. partner’s attitude to HIV status), interactions with health workers (e.g. being given unclear/incorrect HIV-related information) and health services characteristics (e.g. restricted opening hours, long waiting times).ConclusionHIV testing within pregnancy-related services is an important entry point to HIV care and treatment services, but few women successfully completed the steps needed for assessment of their treatment needs within three months of diagnosis. Programmatic recommendations include simplified pathways to care, better-tailored counselling, integration of ART into antenatal services, and facilitation of social support.
Highlights
There has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV
[1] Attention is increasingly being paid to linking women who are diagnosed with HIV in antenatal or delivery services to longterm care and treatment for their own HIV infection. [2]
Five women were excluded at the time of follow-up because quantitative analyses on HIV clinic attendance were based on health facility records and they reported having attended an HIV clinic that was too far away for the study team to access their records
Summary
There has been insufficient attention to long-term care and treatment for pregnant women diagnosed with HIV. [1] Attention is increasingly being paid to linking women who are diagnosed with HIV in antenatal or delivery services (collectively ‘‘pregnancy-related services’’) to longterm care and treatment for their own HIV infection. A recent systematic literature review highlighted sub-optimal linkage into long-term HIV care and treatment services of women diagnosed with HIV during pregnancy. We carried out a retrospective cohort study in Naivasha Hospital, Kenya, between January 2008 and June 2010, finding high attrition along the pathway to HIV care and treatment: within six months of diagnosis with HIV in pregnancy-related services, only 153/892 (17%) women had registered at the on-site HIV clinic. Of 99 women with a recorded CD4 count, 53 were eligible for and only 21 (40%) initiated ART within six months of HIV diagnosis. [5] This review was based on manually-matched hospital records, potentially underestimating uptake of care in nearby health facilities
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