Barriers to accessing highly active antiretroviral therapy by HIV‐positive women attending an antenatal clinic in a regional hospital in western Uganda

Abstract

BackgroundThe aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy (HAART) by HIV-positive mothers in the Ugandan Kabarole District's Programme for the Prevention of Mother to Child Transmission-Plus (PMTCT-Plus).MethodsOur study was a qualitative descriptive exploratory study using thematic analysis. Individual in-depth interviews (n = 45) were conducted with randomly selected HIV-positive mothers who attended this programme, and who: (a) never enrolled in HAART (n = 17); (b) enrolled but did not come back to receive HAART (n = 2); (c) defaulted/interrupted HAART (n = 14); and (d) are currently adhering to HAART (n = 12). A focus group was also conducted to verify the results from the interviews.ResultsResults indicated that economic concerns, particularly transport costs from residences to the clinics, represented the greatest barrier to accessing treatment. In addition, HIV-related stigma and non-disclosure of HIV status to clients' sexual partners, long waiting times at the clinic and suboptimal provider-patient interactions at the hospital emerged as significant barriers.ConclusionsThese barriers to antiretroviral treatment of pregnant and post-natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population. This would improve their survival and, at the same time, drastically reduce HIV transmission from mother to child.

Integrating antiretroviral therapy into antenatal care and maternal and child health settings: a systematic review and meta-analysis

“…39 Furthermore, in qualitative studies from Malawi, 40 Uganda, 41 and Zimbabwe 42 that examined the reasons for losses to follow-up, the main drivers were found to be the following: long queues at HIV clinics; the cost of transport from homes to clinics; fear of disclosure of HIV status; lack of support from partners who did not want to be tested for HIV; and suggestions on the part of staff to not breastfeed their babies and to feed them formula instead (which was a social taboo). Many of these problems could be alleviated by integrating ART into ANC clinics.…”

Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland

“…Data on the importance of these factors in ART acceptance have been questionable, with conflicting results between studies. [10,11,[24][25][26][27][28][29][30][31] Partner support was strongly and independently associated with ART initiation among eligible pregnant women in our study, with the odds of initiating ART 4.8-fold higher in women whose partners supported ART initiation compared with those women whose partners did not support ART initiation (p<0.001). Our study contributes to the body of literature that shows that men's support influences women's decisions to accept ART and PMTCT interventions.…”

“…Other studies have reported that negative interactions between healthcare staff and pregnant women, negative staff attitudes and poor access to ART services can serve as barriers to the uptake of and adherence to PMTCT services by pregnant women. [6,10,40,42,44,45] …”

“…[6][7][8][9][10][11] New WHO guidelines now recommend initiation of life-long therapy in all HIV-infected pregnant and breastfeeding women. Obtaining a better understanding of the factors associated with the acceptance of ART will be critical to implement these recommendations effectively.…”

“…[5] A number of studies identified barriers to ART initiation during pregnancy in southern and eastern Africa, including fear of knowing one's HIV status, lack of male partners' support, negative attitudes of healthcare workers, late presentation in pregnancy, advanced HIV disease, lack of finances, fear of stigma and discrimination, non-disclosure of HIV status and long waiting times. [6][7][8][9][10][11] New WHO guidelines now recommend initiation of life-long therapy in all HIV-infected pregnant and breastfeeding women. Obtaining a better understanding of the factors associated with the acceptance of ART will be critical to implement these recommendations effectively.…”