Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries.

Anita Hardon,Alice Desclaux,Grace Bongololo-Mbera,Carla Obermeyer,Rhoda Wanyenze,Eva Vernooij,Peter Cherutich,David Kyaddondo,Odette Ky-Zerbo,Melissa Neuman

doi:10.1186/1471-2458-12-26

Abstract

BackgroundAmbitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes.MethodsOur mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests.ResultsThe majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband.ConclusionTo achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.

Highlights

IntroductionThe aim was to reduce the proportion of infected children born to HIV-positive mothers by 20% by 2005, and by a further 50% by 2010
Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa
Burkina Faso’s national HIV Counseling and Testing (HCT) policy adds that counselors must respect client “autonomy” and understand their reasons for refusing; it recommends improved counseling for more women to accept testing [35]

Summary

Introduction

The aim was to reduce the proportion of infected children born to HIV-positive mothers by 20% by 2005, and by a further 50% by 2010 These ambitious and uses these findings to suggest how services can be improved to enable better PMTCT outcomes. In 2002, a WHO meeting proposed the inclusion of a fourth pillar: to provide care and support to mothers, their infants and their families [5]. These aims were endorsed at the PMTCT High Level Global Partners Forum in Abuja, Nigeria in 2005 [6], by which time global pressure had made antiretroviral treatment available in resource-poor settings

Objectives

Methods

Results

Discussion

Conclusion