Abstract
BackgroundWomen and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and risks of such integration, this paper considers pregnant women’s and providers’ perceptions about the effects of integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania.MethodsFrom a larger evaluation of an integrated maternal and newborn health care program in Morogoro, Tanzania, this analysis included a subset of information from 203 observations of antenatal care and interviews with 57 providers and 190 pregnant women from 18 public health centers in rural and peri-urban settings. Qualitative data were analyzed manually and with Atlas.ti using a framework approach, and quantitative data of respondents’ demographic information were analyzed with Stata 12.0.ResultsPerceptions of integrating HIV testing with routine antenatal care from women and health providers were generally positive. Respondents felt that integration increased coverage of HIV testing, particularly among difficult-to-reach populations, and improved convenience, efficiency, and confidentiality for women while reducing stigma. Pregnant women believed that early detection of HIV protected their own health and that of their children. Despite these positive views, challenges remained. Providers and women perceived opt out HIV testing and counselling during antenatal services to be compulsory. A sense of powerlessness and anxiety pervaded some women’s responses, reflecting the unequal relations, lack of supportive communications and breaches in confidentiality between women and providers. Lastly, stigma surrounding HIV was reported to lead some women to discontinue services or seek care through other access points in the health system.ConclusionWhile providers and pregnant women view program synergies from integrating HIV services into antenatal care positively, lack of supportive provider-patient relationships, lack of trust resulting from harsh treatment or breaches in confidentiality, and stigma still inhibit women’s care seeking. As countries continue rollout of Option B+, social relations between patients and providers must be understood and addressed to ensure that integrated delivery of HIV counselling and services encourages women’s care seeking in order to improve maternal and child health.
Highlights
Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS
This study found that both pregnant women and providers had positive perceptions of the integration of HIV counselling and testing into antenatal services
This study found that the reported increased uptake of HIV testing could be partly attributed to de-stigmatization of the test, as it became a routine part of and accepted by most women attending antenatal services [36]
Summary
Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. In sub-Saharan Africa, women comprised 60% of people living with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) in 2011, and AIDS was the leading cause of death among mothers [1]. The disproportionate burden of HIV in women has implications for their health and the health of their children. Ninety one percent of children under 15 years living with HIV in 2011 were in sub-Saharan Africa [1]. PMTCT is envisioned as a cascade of services throughout the reproductive, maternal, newborn, and child health spectrum that entails a series of services, including counselling, testing and treatment, delivered at multiple time points throughout a woman’s interaction with the health system
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