“What They Wanted Was to Give Birth; Nothing Else”

Clouse, Kate; Schwartz, Sheree; Rie, Annelies Van; Bassett, Jean; Yende, Nompumelelo; Pettifor, Audrey

doi:10.1097/qai.0000000000000263

Cited by 144 publications

(110 citation statements)

References 31 publications

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“…These findings are in line with other studies [26–31]. A possible explanation is that women only initiated ART for the benefit of the unborn child, because they had limited understanding of the subsequent benefit of ART for their own health and in preventing transmission to their infant during breastfeeding [32, 33]. In addition, 9% of women receiving ART did not return for the first drug refill, similar to findings from another study in Ethiopia [31] which may reflect the importance of early treatment adherence support and retention messages especially for mothers with higher CD4 count at the start of their treatment and clinical follow-up [23].…”

Section: Discussionsupporting

confidence: 90%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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BackgroundUniversal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland.MethodsLifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses.ResultsOf 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+.ConclusionsPMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.

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Section: Discussionsupporting

confidence: 90%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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“…Consistent with other studies, [35, 60] most participants did not associate having sex with HIV reinfection, nor did they acknowledge the risk factor of mother-to-child transmission of HIV. The fulfilment of motherhood, and compliance with social norms, appeared to be more important than preventing HIV-infection through contraceptive use [61]. …”

Section: Discussionmentioning

confidence: 99%

Perceptions and decision-making with regard to pregnancy among HIV positive women in rural Maputo Province, Mozambique – a qualitative study

et al. 2018

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BackgroundIn preventing the transfer of HIV to their children, the Ministry of Health in Mozambique recommends all couples follow medical advice prior to a pregnancy. However, little is known about how such women experience pregnancy, nor the values they adhere to when making childbearing decisions. This qualitative study explores perceptions and decision-making processes regarding pregnancy among HIV positive women in rural Maputo Province.MethodsIn-depth interviews and five focus group discussions with fifty-nine women who had recently become mothers were carried out. In addition, six semi-structured interviews were held with maternity and child health nurses. The ethnographic methods employed here were guided by Bourdieu’s practice theory.ResultsThe study indicated that women often perceived pregnancy as a test of fertility and identity. It was not only viewed as a rite of passage from childhood to womanhood, but also as a duty for married women to have children. Most women did not follow recommended medical advice prior to gestation. This was primarily due to perceptions that decision-making about pregnancy was regarded as a private issue not requiring consultation with a healthcare provider. Additionally, stigmatisation of women living with HIV, lack of knowledge about the need to consult a healthcare provider prior to pregnancy, and unintended pregnancy due to inadequate use of contraceptive were crucial factors.ConclusionWomen’s experiences and decisions regarding pregnancy are more influenced by social and cultural norms than medical advice. Therefore, education concerning sexual and reproductive health in relation to HIV/AIDS and childbearing is recommended. In particular, we recommend maternal and child healthcare nurses need to be sensitive to women’s perceptions and the cultural context of maternity when providing information about sexual and reproductive health.

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“…Supporting adherence during this critical time may require integration of pediatric care and maternal follow-up care and emphasizing the importance of on-going ART adherence for the maternal health in addition to reducing risks of perinatal transmission. Additional data are required from postpartum women in other settings regarding their specific adherence and suppression experiences and challenges, especially as treatment recommendations and implementation evolve [24, 33, 34]…”

Section: Discussionmentioning

confidence: 99%

HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods

Matthews

Ribaudo

Kaida

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on ART in Uganda. Methods We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥ 1 pregnancy between 2005-2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters prior to pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or non-pregnancy-related. Regression models using GEE compared the likelihood of HIV-1 RNA ≤400 copies/mL, <80% average adherence based on electronic pill caps (MEMS), and likelihood of 72-hour medication gaps across each time period. Results 111 women contributed 486 person-years of follow up. Viral suppression was present at 89% of non-pregnant, 97% of periconception, 93% of pregnancy, and 89% of postpartum visits, and was more likely during periconception (aOR 2.15) compared with non-pregnant periods. Average ART adherence was 90% (IQR 70-98%), 93% (IQR 82-98%), 92% (IQR 72-98%) and 92% (IQR 72-97%) during non-pregnant, periconception, pregnant and postpartum periods. Average adherence < 80% was less likely during periconception (aOR 0.68) and 72-hour gaps/90 days were less frequent during periconception (aRR 0.72) and more frequent postpartum (aRR 1.40). Conclusions Women with pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

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“What They Wanted Was to Give Birth; Nothing Else”

Cited by 144 publications

References 31 publications

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Perceptions and decision-making with regard to pregnancy among HIV positive women in rural Maputo Province, Mozambique – a qualitative study

HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods

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