Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi

Levy, Jennifer

doi:10.1016/s0968-8080(09)33436-9

Cited by 27 publications

(34 citation statements)

References 17 publications

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“…Client satisfaction is one of the factors affecting utilization of ANC/PMTCT services. In this study, about 58% of the pregnant women interviewed reported that the amount of time spent during the visit was reasonable, and several studies found that quality of communication skills, comprehensiveness of counseling information, technical competence of the counselor and privacy during counseling are the most important factors affecting the quality of PMTCT services [15, 16, 24, 30, 31]. In order to improve acceptability and uptake of the ANC/PMTCT services, consideration should be given to improve quality of the services.…”

Section: Discussionmentioning

confidence: 99%

“…Though PMTCT service is known to reduce the transmission of HIV from mother to child its use has been limited because of various barriers [11, 24]. This study has revealed multiple social, cultural, economic and physical barriers that might hinder the success of HCT – an entry point for the PMTCT programme in both health centers and hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Utilization of PMTCT services and associated factors among pregnant women attending antenatal clinics in Addis Ababa, Ethiopia

Deressa

Seme

Asefa

et al. 2014

BMC Pregnancy Childbirth

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BackgroundMother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) remains the major source of HIV infection in young children. Targeting pregnant women attending antenatal clinics provide a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT) programmes against HIV infection of newborn babies. This study aimed to investigate factors associated with the acceptability and utilization of PMTCT of HIV.MethodsAn institution based cross-sectional study was conducted in April 2010 using exit interviews with 843 pregnant women attending antenatal care (ANC) clinics of 10 health centers and two hospitals in Addis Ababa, Ethiopia. Trained nurses administered structured questionnaires to collect data on socio-demographic characteristics, knowledge about MTCT, practice of HIV testing and satisfaction with the antenatal care services. Six focus group discussions among pregnant women and 22 in-depth interviews with service providers complemented the quantitative data.ResultsAbout 94% of the pregnant women visited the health facility for ANC check-up. Only 18% and 9% of respondents attended the facility for HIV counselling and testing (HCT) and receiving antiretroviral prophylaxis, respectively. About 90% knew that a mother with HIV can pass the virus to her child, and MTCT through breast milk was commonly cited by most women (72.4%) than transmission during pregnancy (49.7%) or delivery (49.5%). About 94% of them reported that they were tested for HIV in the current pregnancy and 60% replied that their partners were also tested for HIV. About 80% of the respondents reported adequacy of privacy and confidentiality during counseling (90.8% at hospitals and 78.6% at health centers), but 16% wished to have a different counselor. Absence of counselors, poor counselling, lack of awareness and knowledge about HCT, lack of interest and psychological unpreparedness were the main reasons cited for not undergoing HIV testing during the current pregnancy.ConclusionsHIV testing among ANC attendees and knowledge about MTCT of HIV was quite high. Efforts should be made to improve the quality and coverage of HCT services and mitigate the barriers preventing mothers from seeking HIV testing. Further research should be conducted to evaluate the uptake of antiretroviral prophylaxis among HIV-positive pregnant women attending ANC clinics.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-328) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Utilization of PMTCT services and associated factors among pregnant women attending antenatal clinics in Addis Ababa, Ethiopia

Deressa

Seme

Asefa

et al. 2014

BMC Pregnancy Childbirth

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“…Facilitators to staying in pregnancy PMTCT include participation in community based interventions, such access to “mentor mothers,” peer educators/counselors, and partner incorporation into counseling [19,20,23,32]. The strong desire to deliver a healthy baby has also been associated with engagement in PMTCT [33]. …”

Section: Existing Datamentioning

confidence: 99%

“…Existing data shows that women who are ineligible for lifetime treatment and/or have a higher CD4 count may be more likely to fall out of care during the postpartum period [40,41]. The prevailing view that PMTCT is not for the mother [33,45] may contribute to this phenomenon.…”

Section: Gaps and Recommendationsmentioning

confidence: 99%

Adherence to HIV Care After Pregnancy Among Women in Sub-Saharan Africa: Falling Off the Cliff of the Treatment Cascade

et al. 2015

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Increased access to testing and treatment means HIV can be managed as a chronic illness, though successful management requires continued engagement with the healthcare system. Most of the global HIV burden is in sub-Saharan Africa where rates of new infections are consistently higher in women versus men. Pregnancy is often the point at which an HIV diagnosis is made. While PMTCT interventions significantly reduce the rate of vertical transmission of HIV, women must administer ARVs to their infants, adhere to breastfeeding recommendations, and test their infants for HIV after childbirth. Some women will be expected to remain on the ARVs initiated during the pregnancy period, while others are expected to engage in routine testing so treatment can be reinitiated when appropriate. The postpartum period presents many barriers to sustained treatment adherence and engagement in care. While some studies have examined adherence to postpartum PMTCT guidelines, few have focused on continued engagement in care by the mother, and very few examine adherence beyond the six week postpartum visit. Here, we attempt to identify gaps in the research literature and make recommendations on how to address barriers to ongoing postpartum HIV care.

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“…This was consistent with other studies which showed that women may refuse ARVs for PMTCT because they doubted their efficacy or they feared that ARVs could harm the unborn child. [40][41][42][43] In our study, both healthcare workers' attitudes towards pregnant women and women's perceptions of access to ART were associated with ART initiation in univariate, but not multivariate, analyses. 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.…”

Section: Discussionmentioning

confidence: 55%

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

et al. 2017

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Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 -5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 -10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented. Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland Prior to 2013, antiretroviral therapy (ART) was recommended by the World Health Organization (WHO) for HIV-infected pregnant women with CD4 cell counts of <350 cells/µL or those who were at WHO clinical stage III or IV Women who did not meet these criteria,were advised to use one of two options. Option A: antepartum zidovudine, with single-dose nevirapine during labour, and a 7-day zidovudine/lamivudine 'tail' alongside daily infant nevirapine during breastfeeding. Option B: ART during pregnancy and through cessation of breastfeeding to prevent mother-to-child HIV transmission (PMTCT.) [1] Many countries, including Swaziland, chose to implement option A; a CD4 cell count was performed on all women identified to have HIV infection to determine those who should be initiated on life-long ART for both maternal health and PMTCT. In Swaziland, 88% of facilities that provide antenatal care (ANC) services also provide PMTCT services.[2] In 2009, 73% of women attending ANC facilities were tested for HIV, and 88% of HIV-infected pregnant women received a complete course of PMTCT prophylaxis in 2009. [3] However, a review of the data in the Early Infant Diagnosis (EID) database in Swaziland at the time of the introduction of option A guidelines, showed that ~50% of HIV-infected women who were eligible for ART actu...

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Women’s expectations of treatment and care after an antenatal HIV diagnosis in Lilongwe, Malawi

Cited by 27 publications

References 17 publications

Utilization of PMTCT services and associated factors among pregnant women attending antenatal clinics in Addis Ababa, Ethiopia

Utilization of PMTCT services and associated factors among pregnant women attending antenatal clinics in Addis Ababa, Ethiopia

Adherence to HIV Care After Pregnancy Among Women in Sub-Saharan Africa: Falling Off the Cliff of the Treatment Cascade

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

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