Abstract
Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions.
Highlights
Despite the availability of evidence-based interventions to prevent mother to child transmission (PMTCT) of HIV, an estimated 150,000 incident HIV infections and 110,000 AIDS related deaths occurred among children less than 15 years of age in 2015 [1]
The results reveal that pregnant women diagnosed with HIV at their first visit to antenatal care (ANC) choose to participate in the PMTCT program by continually assessing and reacting to perceived risks and benefits in the home, community and clinic environments (Fig 1)
This study goes beyond describing discrete barriers to participating in PMTCT services, and explains a dynamic analysis of actual and perceived risks in the home, community, and clinic that begins when a woman is diagnosed with HIV at her first ANC visit
Summary
Despite the availability of evidence-based interventions to prevent mother to child transmission (PMTCT) of HIV, an estimated 150,000 incident HIV infections and 110,000 AIDS related deaths occurred among children less than 15 years of age in 2015 [1]. In 2011, global and national leaders set ambitious targets as part of The Global Plan to substantially decrease new HIV infections in children and reduce mortality among mothers living with HIV, including a 90% reduction in child HIV infections, a 50% reduction in AIDS-related maternal deaths, and virtual elimination of mother to child transmission (eMTCT: defined as reducing mother to child transmission (MTCT) to less than 5%) [2, 3]. To achieve eMTCT, HIV-positive women and their babies must be enrolled and retained in PMTCT programs and adhere to ART. Recent review articles estimate that maternal adherence to antiretrovirals and LTFU of mother-infant pairs from PMTCT programs in Sub-Saharan Africa (SSA) range from 35–86% [6] and 19%-90%, respectively [7]
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