Experiences of HIV-positive postpartum women and health workers involved with community-based antiretroviral therapy adherence clubs in Cape Town, South Africa

Abstract

BackgroundThe rollout of universal, lifelong treatment for all HIV-positive pregnant and breastfeeding women (“Option B+”) has rapidly increased the number of women initiating antiretroviral treatment (ART) and requiring ART care postpartum. In a pilot project in South Africa, eligible postpartum women were offered the choice of referral to the standard of care, a local primary health care clinic, or a community-based model of differentiated ART services, the adherence club (AC). ACs have typically enrolled only non-pregnant and non-postpartum adults; postpartum women had not previously been referred directly from antenatal care. There is little evidence regarding postpartum women’s preferences for and experiences of differentiated models of care, or the capacity of this particular model to cater to their specific needs. This qualitative paper reports on feedback from both postpartum women and health workers who care for them on their respective experiences of the AC.MethodsOne-on-one in-depth qualitative interviews were conducted with 19 (23%) of the 84 postpartum women who selected the AC and were retained at approximately 12 months postpartum, and 9 health workers who staff the AC. Data were transcribed and thematically analysed using NVivo 11.ResultsPostpartum women’s inclusion in the AC was acceptable for both participants and health workers. Health workers were welcoming of postpartum women but expressed concerns about prospects for longer term adherence and retention, and raised logistical issues they felt might compromise trust with AC members in general.ConclusionsEnrolling postpartum women in mixed groups with the general adult population is feasible and acceptable. Preliminary recommendations are offered and may assist in supporting the specific needs of postpartum women transitioning from antenatal ART care.Trial registrationNumber NCT02417675 clinicaltrials.gov/ct2/show/record/NCT02417675 (retrospective reg.)

Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

“…In a cohort study of 129 women with HIV viral load <1000 copies/mL for at least three months, Myer and colleagues reported favourable outcomes with adherence groups during the postpartum period [87]. The feasibility and acceptability of the approach was confirmed via in‐depth interviews with healthcare providers and patients [88]. Although encouraging, further research is needed about patient preferences and long‐term outcomes in this population.…”

“…Similarly, mobile health (or mHealth) technologies have been shown to improve retention and adherence across numerous studies in the general adult HIV population but studies focused on antenatal and postpartum populations have been limited. In separate trials, two‐way messaging and biweekly phone calls were associated with increased retention within the first eight to ten weeks following delivery [88,89]; however, data for longer term retention (i.e. out to 12 months postpartum) appear equivocal [90].…”

Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12‐month cohort study in urban South Africa and rural Uganda

“…In addition, studies addressing structural factors showed promising results with integration of postpartum care into routine care for the child or family [66] [67], mHealth reminders and cash transfers [68][69][70][71][72]. Ongoing studies will evaluate effects of mHealth strategies [73,74], reaching women with mental health challenges in pregnancy and postpartum [75,76] and adherence clubs/decentralized care [77]. Women in different contexts will require different types of support [78,79] and an adaptive trial design [80] may be an efficient way to evaluate strategies to combine intervention elements to support women to remain in care [81].…”

Provider‐ and patient‐level costs associated with providing antiretroviral therapy during the postpartum phase to women living with HIV in South Africa: A cost comparison of three postpartum models of care

“…The PACER study enrolled 129 postpartum breastfeeding WLH who initiated ART during their recently completed pregnancy, who met local criteria for CAC membership [20,21,28]. Eligible women were offered a choice for postpartum ART care: Model I (as described above) or Model IIIreferral directly to a CAC with their infants receiving care at well-baby clinics.…”