Abstract
ABSTRACTBackground: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved.Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa.Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward.Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child’s health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs.Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.
Highlights
HIV/AIDS has had a significant impact on maternal and child health in South Africa
The code ‘negligence’ as a cause of HIV for example, became part of the subtheme ‘patients who do not take responsibilities’ under the theme ‘problems ascribed to the patients’ and the category ‘problem definition’ as part of the health care providers (HCPs) perspective [26]
The HCPs appeared to apply three main themes relating to their interaction with patients during prevent mother-to-child transmission of HIV (PMTCT)
Summary
It is of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCTrelated care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. In the last five to ten years South Africa has made substantial progress in MCH, partly due to the scale-up of interventions that prevent HIV transmission from mother-to-child (PMTCT) [2]. PMTCT interventions include HIV testing and counselling in pregnant women during antenatal and postnatal care, strengthening retention in care and adherence to triple antiretroviral therapy (ART), and providing appropriate treatment, care and support [4]. It is important to reach HIV-positive women in early pregnancy to initiate PMTCT interventions
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