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Belachew TW, Erega BB, Ewunetu M, Gelaye K, Yimer TS, Ferede WY. Level of option B plus drug adherence for preventing mother-to-child transmission of HIV and associated factors among HIV-positive women in the awi zone, amhara region, northwest Ethiopia,2020. Heliyon 2024; 10:e35319. [PMID: 39161839 PMCID: PMC11332886 DOI: 10.1016/j.heliyon.2024.e35319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Adherence to Option B+ antiretroviral medication (ART) is essential for the successful implementation of the Prevention of Mother-to-Child Transmission (PMTCT) program. However, poor adherence to Option B + PMTCT drugs among women results in increased viral load and mother-to-child transmission and reduces immunological and clinical outcomes. Objective The objective of the study was to assess the level of Option B plus drug adherence for preventing mother-to-child transmission of HIV and associated factors among HIV positive women in selected government health facilities of Awi zone, Amhara region, Northwest Ethiopia,2020. Methods This institutional-based cross-sectional study was conducted from March 1 to April 30 among 358 HIV-positive women (pregnant and lactating mothers). A multistage sampling procedure was used to select the study participants. Data were collected using a structured questionnaire through interviews. The collected data were entered into EPI Data 3.1 statistical software for data management and analyzed using SPSS version 25 statistical package. The associations between variables were analyzed using bivariate and multivariable logistic regression models. A p-value ≤0.05 at the 95 % confidence interval was considered statistically significant. Results Out of the 358 participants, adherence to Option B + PMTCT was 83.24 %. The study revealed that counselling [AOR = 4.4, 95 % CI: 1.60-12.29], partner support involvement [AOR = 3.0, 95 % CI: 1.17-7.92], and time taken to reach from home to the facility [AOR = 3.1, 95 % CI: 1.51-6.52] were significantly associated with the level of adherence to Option B + PMTCT. Conclusion This study showed that the level of Option B + PMTCT drug adherence was lower than the nationally recommended adherence level. Good counselling, partner support, and reduced travel time from home to the facility were associated with adherence to Option B + PMTCT drugs. Therefore, counselling is crucial for increasing adherence to Option B + PMTCT drugs. Accessible health facilities reduce travel burdens, encourage regular clinic visits, and enhance adherence to PMTCT drugs. Partners can provide reminders, attend appointments, offer emotional support, and explore alternatives such as mobile clinics or medication delivery services.
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Affiliation(s)
- Tegegne Wale Belachew
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Besfat Berihun Erega
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Mesafint Ewunetu
- Department of Midwifery College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Kihinetu Gelaye
- Department of Midwifery College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Tigist Seid Yimer
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Wassie Yazie Ferede
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
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Dadi TL, Wiemers AMC, Tegene Y, Medhin G, Spigt M. Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis. AIDS Res Ther 2024; 21:7. [PMID: 38297363 PMCID: PMC10829476 DOI: 10.1186/s12981-024-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.
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Affiliation(s)
- Tegene Legese Dadi
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia.
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands.
| | - Anja M C Wiemers
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Yadessa Tegene
- School of Public Health, College of Medicine & Health Science, Hawassa University, Hawassa, Ethiopia
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Mark Spigt
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsö, Norway
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Sakyi KS, Hurley EA, Kanyangarara M, Owusu PG, Sowah LA, Lartey M, Jackson F, Sacks E. Over forty percent of women living with HIV report interruption in antiretroviral therapy during intrapartum and early postpartum inpatient stay: findings from five hospitals in Ghana. AIDS Care 2024; 36:139-145. [PMID: 37723120 DOI: 10.1080/09540121.2023.2254546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/27/2023] [Indexed: 09/20/2023]
Abstract
Antiretroviral therapy (ART) adherence during and after pregnancy is essential to reduce perinatal transmission of HIV. However, little is known about adherence during the intrapartum and early postpartum inpatient hospital stay. Using secondary data from a hospital-based cohort study focused on the relationship between birthweight and engagement in HIV care, we examined the magnitude of, reasons for, and factors associated with incomplete intrapartum and early postpartum ART adherence among adult women (18 years or older) living with HIV who delivered within the previous two weeks at one of five hospitals in Accra, Ghana. Of the 142 enrolled participants who had complete adherence data and reported being on ART at the time of hospital admission, 43% (61/142) reported missing at least one ART dose during labor, delivery, and postpartum, including almost 20% (28/142) missing 2 or more consecutive doses. Women who reported frequently missing ART doses during pregnancy had higher odds of reporting missed doses during their intrapartum and postpartum hospital stays. Among those with inpatient ART interruption, the most frequently cited reasons were: forgetting medication at home (42%) and challenges of being in or recovering from labor (29%). Maternal perception of infant health at birth, hospital level of care, and frequency of missing HIV medications during pregnancy were associated with incomplete ART adherence during the intrapartum and early postpartum inpatient stay. An enabling clinical environment to facilitate access to ART during inpatient stays may have positive implications for ART adherence.
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Affiliation(s)
- Kwame S Sakyi
- School of Health Sciences, Oakland University, Rochester, MI, USA
- Center for Learning and Childhood Development, Accra, Ghana
| | - Emily A Hurley
- Center for Learning and Childhood Development, Accra, Ghana
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Mufaro Kanyangarara
- Center for Learning and Childhood Development, Accra, Ghana
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Prince G Owusu
- Center for Learning and Childhood Development, Accra, Ghana
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | | | - Margaret Lartey
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Emma Sacks
- Center for Learning and Childhood Development, Accra, Ghana
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Deynu M, Nutor JJ. Determinants of comprehensive knowledge on mother-to-child transmission of HIV and its prevention among childbearing women in Rwanda: insights from the 2020 Rwandan Demographic and Health Survey. BMC Public Health 2023; 23:5. [PMID: 36593470 PMCID: PMC9809025 DOI: 10.1186/s12889-022-14925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Maternal knowledge on mother-to-child transmission (MTCT) and its prevention has been identified to enhance maternal testing and adherence to antiretroviral therapy (ART) regimen. Examining prevalence and associated factors on MTCT and its prevention among women provides empirical evidence for design and implementation of health strategies aimed at increasing MTCT knowledge and its elimination. This study therefore examined women's comprehensive knowledge and associated factors on MTCT and its prevention among childbearing women in Rwanda. METHODS Analysis was conducted on a weighted sample of 14,634 women from the 2020 Rwanda Demographic and Health Survey (RDHS). Dataset cleaning and missing value analysis was conducted. Chi square, bivariate and multivariable regression was then conducted in complex samples in SPSS. Alpha level set at p < 0.05 and at 95% Confidence Interval (95% CI). All analysis were adjusted for unequal probability sampling using survey weights. Bivariate and multivariable results were reported with crude and adjusted odds ratios. RESULTS The mean age was 29.2 years, SD-9.1. Prevalence of HIV testing and comprehensive knowledge on MTCT and its prevention among women in Rwanda was 79.6% and 65.1% respectively. Findings from this study showed that married women have higher odds (aOR = 1.18, 95% CI = 1.04-1.35) of comprehensive knowledge on MTCT and its prevention compared to those unmarried. Women who were living in southern (aOR = 1.23, 95%CI = 1.02-1.48) and eastern (aOR = 1.37, 95% CI = 1.13-1.66) parts of Rwanda were more likely to have adequate knowledge on MTCT of HIV and its prevention than those in Kigali. Also, women who received post-test counselling (aOR = 1.26, 95% CI = 1.01-2.11) have increased knowledge on MTCT than those who did not. Women with access to radio (aOR = 1.18, 95% CI = 1.06-1.32) and television (aOR = 1.25, 95% CI = 1.07-1.45) at least once a week were more likely to have adequate knowledge on MTCT and its prevention compared to those who do not in Rwanda. CONCLUSION There is inadequate knowledge on MTCT and its elimination among women of reproductive age in Rwanda. Strategies to enhance knowledge on MTCT and its prevention among childbearing women should be adopted through rigorous educational sensitization campaigns using local media such as radio and television. Health services that focus on prevention of MTCT must emphasize post-test counselling.
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Affiliation(s)
| | - Jerry John Nutor
- grid.266102.10000 0001 2297 6811Family Health Care Nursing Department, School of Nursing, University of California, San Francisco, 2 Koret Way, CA San Francisco, USA
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Mabachi NM, Brown M, Wexler C, Goggin K, Maloba M, Olungae D, Gautney B, Finocchario-Kessler S. "Friendly reminder: hi! It is that time again ☺": understanding PMTCT care text message design preferences amongst pre- and post-partum women and their male partners. BMC Public Health 2021; 21:1491. [PMID: 34340672 PMCID: PMC8330020 DOI: 10.1186/s12889-021-11444-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/01/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prevention of mother-to-child HIV transmission (PMTCT) services in Kenya can be strengthened through the delivery of relevant and culturally appropriate SMS messages. METHODS This study reports on the results of focus groups conducted with pre and postnatal women living with HIV (5 groups, n = 40) and their male partners (3 groups, n = 33) to elicit feedback and develop messages to support HIV+ women's adherence to ART medication, ANC appointments and a facility-based birth. The principles of message design informed message development. RESULTS Respondents wanted ART adherence messages that were low in verbal immediacy (ambiguous), came from an anonymous source, and were customized in timing and frequency. Unlike other studies, low message immediacy was prioritized over customization of message content. For retention, participants preferred messages with high verbal immediacy-direct appointment reminders and references to the baby-sent infrequently from a clinical source. CONCLUSION Overall, participants favored content that was brief, cheerful, and emotionally appealing.
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Affiliation(s)
- Natabhona M Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Children's Mercy Hospitals and Clinics, Health Services and Outcomes Research, Kansas City, MO, USA
| | - May Maloba
- Global Health Innovations (GHI), Nairobi, Kenya
| | - Dama Olungae
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Brad Gautney
- Global Health Innovations (GHI), Dallas, Texas, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
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Macharia PM, Joseph NK, Sartorius B, Snow RW, Okiro EA. Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014. BMJ Glob Health 2021; 6:e004544. [PMID: 33858833 PMCID: PMC8054106 DOI: 10.1136/bmjgh-2020-004544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya. METHODS Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014. RESULTS Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993-2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria. CONCLUSION The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.
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Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Wexler C, Brown M, Maloba M, Goggin K, Mabachi N, Kamau Y, Gautney B, Koech S, Lagat S, Finocchario-Kessler S. Women's preferences, expectations, and experiences with male partner support throughout prevention of mother to child transmission of HIV services: a mixed-methods study. AIDS Care 2020; 33:1059-1067. [PMID: 33300370 DOI: 10.1080/09540121.2020.1859444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Male involvement in prevention of mother to child transmission of HIV (PMTCT) care improves maternal and child outcomes. We conducted a mixed-methods study at two Kenyan government hospitals. We quantitatively assessed women's expectations and preferences for male partner involvement in PMTCT and male partner attendance at PMTCT appointments. Qualitative interviews with women during the postpartum period assessed types of support women received from their male partners. At enrollment, most participants wanted (75%) and expected (69%) male partners to attend appointments; yet, only 9% had a male partner attend any appointments. Most women agreed that their partner would: support them financially (81%), help follow doctor's guidance (61%), support a hospital-based delivery (85%), and want to receive text messages (68%). Expectations and preferences varied by women's characteristics, most notably experiences with mistreatment, disclosure status, and knowledge of male partner's HIV status. In qualitative interviews, instrumental (financial) support was the most frequently discussed type of support. Male partners also provided informational support by reminding women of medication or appointments. Women reported a variety of ways in which their male partners supported them through PMTCT; however, there was a gap between women's expectation for male partner attendance and the level of male attendance achieved.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Yvonne Kamau
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Sharon Koech
- Kenya Medical Research Institute, Nairobi, Kenya
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Mabachi NM, Brown M, Sandbulte M, Wexler C, Goggin K, Maloba M, Finocchario-Kessler S. Using a Social Support Framework to Understand How HIV Positive Kenyan Men Engage in PMTCT/EID Care: Qualitative Insights From Male Partners. AIDS Behav 2020; 24:18-28. [PMID: 30877581 PMCID: PMC6745277 DOI: 10.1007/s10461-019-02451-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Greater male partner involvement in Prevention of Mother to Child Transmission (PMTCT) and Early Infant Diagnosis (EID) is associated with improved outcomes. Perceived low social support for the mother can negatively impact the uptake of PMTCT/EID services. Most research relies on women's reports of the types and quality of male partner support received versus what is desired. This qualitative study examines Kenyan male partners' reported social support provision pre- and post-partum from their own perspective. The study was embedded within intervention development studies in Kenya designed to develop and pilot a PMTCT module of a web based system to improve EID. Focus groups were conducted with male partners of pregnant women with HIV and elicited feedback on male partner involvement in maternal and child care and factors affecting participation. Interviews were analyzed within a theoretical social support framework. Participants described providing tangible support (financial resources), informational support (appointment reminders) and emotional support (stress alleviation in the face of HIV-related adversity). African conceptualizations of masculinity and gender norms influenced the types of support provided. Challenges included economic hardship; insufficient social support from providers, peers and bosses; and HIV stigma. Collaboration among providers, mothers and partners; a community-based social support system; and recasting notions of traditional masculinity were identified as ways to foster male partner support.
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Affiliation(s)
- Natabhona M Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Matthew Sandbulte
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Children's Mercy Kansas City, Health Services and Outcomes Research, Kansas City, MO, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
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Nyoni S, Sweet L, Clark J, Ward P. A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts. BMC Public Health 2019; 19:570. [PMID: 31088541 PMCID: PMC6518720 DOI: 10.1186/s12889-019-6949-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most recent World Health Organization (WHO) guidelines on Human Immunodeficiency Virus (HIV) and infant feeding promotes exclusive breastfeeding (EBF) in resource limited settings for the prevention of mother to child transmission (PMTCT) of HIV. Literature reveals poor uptake of WHO feeding guidelines, with mixed feeding being a regular practice. In light of the limited success in EBF promotion, a realist review was conducted, analysing the use of feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa, where the majority of HIV childhood infections occur. We considered what mechanisms were at play, for whom and in what circumstances they led to exclusive breastfeeding. METHODS Because infant feeding counselling is a complex social intervention with a non-linear causal pathway for preventing mother to child HIV transmission, a realist methodology was chosen for this study. Using Pawson's five stage sequence for conducting realist reviews, the results are presented as a set of identified and refined context-mechanism-outcome (CMO) configurations. These CMO configurations were used to show how particular outcomes occurred in specific contexts due to a generative mechanism and were developed through identifying a review question and program theory, searching for primary studies, quality appraisal, data extraction and data synthesis. RESULTS From an initial 1010 papers, 27 papers met the inclusion criteria and were used to refine the program theory. Exclusive breastfeeding occurred when a woman was motivated regarding motherhood, had correct learning and understanding about infant feeding practices through counselling, no fear of breastfeeding or the impact of opposing feeding related cultural beliefs, and the support from others to be assertive about their feeding choices when faced with pressure to mix-feed. An additional CMO configuration was added during the refinement of the program theory identifying that mothers needed to not just understand but also prioritize EBF advice over cultural beliefs and stigma. CONCLUSION The intended audience for this review are researchers and health care workers in PMTCT, particularly sub-Saharan Africa, who may benefit from the work that has been done to identify contexts for the success and failures of EBF.
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Affiliation(s)
- Simangaliso Nyoni
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
| | - Jacinta Clark
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Omonaiye O, Kusljic S, Nicholson P, Mohebbi M, Manias E. Post Option B+ implementation programme in Nigeria: Determinants of adherence of antiretroviral therapy among pregnant women with HIV. Int J Infect Dis 2019; 81:225-230. [PMID: 30790723 DOI: 10.1016/j.ijid.2019.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Nigeria has the highest rate of mother to child transmission of HIV (MTCT) in the world. By 2015, all Global Plan priority countries, except Nigeria, had adopted the Option B+ programme. Nigeria finally adopted Option B+ in 2016 with full implementation reported in 2017. We examined adherence to antiretroviral therapy (ART) among pregnant women since the rollout of Option B+ in Nigeria. METHODS A cross sectional approach was adopted that involved dissemination of a survey (Adult AIDS Clinical Trial Groups [AACTG] standardised survey) to HIV positive pregnant women, to assess adherence to ART. This study was conducted from February to June, 2018 in four health care sites in Akwa Ibom State, in the South-South region of Nigeria. Bootstrapping was used to estimate the 95% confidence interval of the prevalence of adherence. Bivariate associations between patient demographic characteristics and medication taking behaviours, and the outcome variable of ART adherence were examined using Chi-square tests. Multivariable logistic regression was used to identify factors independently associated with adherence. RESULTS Of the 275 women (response rate=92.6%), 32.7% (95% CI: 26.9-38.5) self-reported taking all ART doses in the past 96 hours. In the multivariable logistic regression analyses, there were positive associations between an increased education level (OR=1.7, p=0.006) and disclosure of HIV status (OR=2.3, p=0.024), and medication adherence. For women who had previous prevention of MTCT exposure, the odds of medication adherence were 2.5 times higher compared with those with no previous MTCT exposure (OR=2.5, p=0.005). CONCLUSION Adherence to ART among pregnant women in Nigeria is low. There is a need to improve adherence during pregnancy under the Option B+ programme in Nigeria.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
| | - Snezana Kusljic
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Pat Nicholson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mohammadreza Mohebbi
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
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Lyatuu GW, Naburi H, Urrio R, Mwashemele SZ, Mdingi S, Panga R, Koda H, Chende Y, Tsere M, Mhalu A, Siril H, Lema IA, Aris E, Muya AN, Galanti MR, Biberfeld G, Kilewo C, Ekström AM. Engaging community leaders to improve male partner participation in the prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania. PLoS One 2018; 13:e0207986. [PMID: 30540794 PMCID: PMC6291081 DOI: 10.1371/journal.pone.0207986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Male partner participation improves uptake, retention and outcomes of prevention of mother-to-child transmission of HIV (PMTCT) services. However, in patriarchal settings few men accompany their partners to antenatal care (ANC) and PMTCT services. We explored whether community leaders can improve male partner participation in ANC and PMTCT. Methods We integrated initiatives to increase male partner participation in routine ANC care in six health facilities (attending about 4,500 new pregnant women per quarter) in Dar es Salaam, Tanzania in 2015/16. These initiatives were adapted from a best performing health facility, on male partner participation in ANC and PMTCT, referred to as the “best practice site”. At the six purposively selected intervention sites, we sensitized and garnered commitment from healthcare providers to provide couple friendly services. We then worked with the providers to sensitize and engage community leaders to integrate and promote male partner participation initiatives in their routine community activities. We assessed change in male partner participation in ANC and PMTCT using the proportion of women testing for HIV together with their partners (i.e. couple HIV testing) by quarter. We used 203 ANC facilities (attending about 31,000 new pregnant women per quarter) in the same area as control sites. Results After one year, couple HIV testing in the six intervention sites had tripled from 11.9% at baseline to 36.0% (p<0.001) while there was very little change (from 17.7% to 18.3%) in the 203 control sites (p = 0.07). Statistically significant improvements in couple testing were observed in four of the six intervention sites (6.7% to 19.1%; 9.3% to 74.6%; 46.2% to 95.2%; and 4.7% to 15.1% respectively. p<0.001 for all sites). Two of these four sites, located in the same administrative district as the best practice site, achieved remarkably high couple HIV testing (95.2% and 74.6%). This may be attributable to the greater engagement and active participation of the community leaders in these two sites compared to the other four. Conclusion Effective engagement and functional partnerships between healthcare providers and community leaders can contribute to improve male partner participation in ANC and PMTCT services. PMTCT programs should capitalize on community leaders, in addressing low male partner participation in ANC and PMTCT, in order to improve effective uptake, retention and outcomes of HIV prevention and treatment services among pregnant and breastfeeding women, their partners, infants and families.
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Affiliation(s)
- Goodluck Willey Lyatuu
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Helga Naburi
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roseline Urrio
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sarah Mdingi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Rehema Panga
- Ubungo Municipal Council, Dar es Salaam, Tanzania
| | - Happiness Koda
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Yusuph Chende
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Martha Tsere
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Aisa Mhalu
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Helen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Eric Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Aisa Nkya Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Gunnel Biberfeld
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Charles Kilewo
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Mia Ekström
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease, Karolinska university hospital, Stockholm, Sweden
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Alemu YM, Habtewold TD, Alemu SM. Mother's knowledge on prevention of mother-to-child transmission of HIV, Ethiopia: A cross sectional study. PLoS One 2018; 13:e0203043. [PMID: 30204752 PMCID: PMC6133350 DOI: 10.1371/journal.pone.0203043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women attending antenatal care in Northern Ethiopia. METHODS A total of 416 pregnant women were interviewed between October 2012 and May 2013. Logistic regression analysis was used to identify factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV. RESULTS The proportion of pregnant women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV, was 52%. The odds of having comprehensive knowledge on prevention of mother-to-child transmission of HIV were higher among pregnant women who were younger (16 to 24 years old) (Adjusted Odds Ratio (AOR) = 2.95; 95%CI: 1.20, 7.26), urban residents (AOR = 2.45; 95%CI: 1.39, 4.32), attending secondary education and above (AOR = 4.43; 95%CI: 2.40, 8.20), employed (AOR = 4.99;95%CI: 2.45, 10.16), have five children or more (AOR = 9.34; 95%CI:3.78, 23.07), have favored attitude towards HIV positive living (AOR = 2.53; 95%CI: 1.43, 4.44) and have perceived susceptibility to HIV (AOR = 10.72; 95%CI: 3.90, 29.39). CONCLUSION The proportion of women who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study setting was low. Measures which will escalate mother's knowledge on prevention of mother-to-child transmission of HIV should be emphasized. Efforts to improve mother's knowledge on prevention of mother-to-child transmission of HIV should target women who were older age (> = 35years), rural residents, unemployed, not attending formal education, primigravids, have no favored attitude towards HIV positive living and have not perceived susceptibility to HIV.
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Affiliation(s)
- Yihun Mulugeta Alemu
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sisay Mulugeta Alemu
- International Medical Corps, Mental Health and Psychosocial Support Program, Dollo Ado Refugee Camp, Dollo Ado, Ethiopia
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Omonaiye O, Kusljic S, Nicholson P, Manias E. Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:805. [PMID: 29945601 PMCID: PMC6020364 DOI: 10.1186/s12889-018-5651-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antiretroviral therapy (ART) is a core strategy proposed by the World Health Organization in preventing mother to child transmission (MTCT) of HIV. This systematic review aimed to examine the enablers and barriers of medication adherence among HIV positive pregnant women in sub-Saharan Africa. METHODS We used the following keywords: HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR "PMTCT Cascade" OR "Vertical Transmission" OR "Mother-to-Child") AND (Prevent OR Prevention) AND (HAART OR "Antiretroviral Therapy" OR "Triple Therapy") AND (Retention OR Concordance OR Adherence OR Compliance) to conduct electronic searches in the following databases: MEDLINE Complete (1916-Dec 2017), Embase (1947-Dec 2017), Global Health (1910-Dec 2017) and CINAHL Complete (1937-Dec 2017). Of the four databases searched, 401 studies were identified with 44 meeting the inclusion criteria. Seven studies were added after searching reference lists of included articles, resulting in 51 articles in total. RESULTS The review demonstrated that stigma, cost of transportation, food deprivation and a woman's disclosure or non-disclosure of her HIV status to a partner, family and the community, could limit or define the extent of her adherence to prescribed antiretroviral drugs during pregnancy. Furthermore, the review indicated that knowledge of HIV status, either before or during pregnancy, was significantly associated with medication adherence. Women who knew their HIV status before pregnancy demonstrated good adherence while women who found out their HIV infection status during pregnancy were linked with non-adherence to ART. CONCLUSION This review revealed several barriers and enablers of adherence among pregnant women taking ART in sub-Saharan Africa. Major barriers included the fear of HIV infection status disclosure to partners and family members, stigma and discrimination. A major enabler of adherence in women taking ART was women's knowledge of their HIV status prior to becoming pregnant. Enhanced effort is needed to facilitate women's knowledge of their HIV status before pregnancy to enable disease acceptance and management, and to support pregnant women and her partner and family in dealing with fear, stigma and discrimination about HIV.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia.
| | - Snezana Kusljic
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Pat Nicholson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia
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Thomson KA, Telfer B, Opondo Awiti P, Munge J, Ngunga M, Reid A. Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care. PLoS One 2018; 13:e0191463. [PMID: 29364979 PMCID: PMC5783372 DOI: 10.1371/journal.pone.0191463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 01/05/2018] [Indexed: 11/18/2022] Open
Abstract
Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions.
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Affiliation(s)
- Kerry A Thomson
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Nairobi, Kenya
| | - Barbara Telfer
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Nairobi, Kenya
| | | | - Jane Munge
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Nairobi, Kenya
| | | | - Anthony Reid
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Luxembourg City, Luxembourg
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15
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Nabwera HM, Jepkosgei J, Muraya KW, Hassan AS, Molyneux CS, Ali R, Prentice AM, Berkley JA, Mwangome MK. What influences feeding decisions for HIV-exposed infants in rural Kenya? Int Breastfeed J 2017; 12:31. [PMID: 28717383 PMCID: PMC5508793 DOI: 10.1186/s13006-017-0125-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/05/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya. METHODS We used a qualitative study design. Between March and August 2011, we conducted in-depth interviews (n = 9) and focus group discussions (n = 10) with purposively selected hospital and community respondents at Kilifi County Hospital, Kenya. These respondents had all experienced of infant feeding in the context of HIV. These interviews were informed by prior structured observations of health care worker interactions with carers during infant feeding counselling sessions. RESULTS Overall, women living with HIV found it difficult to adhere to the HIV infant feeding guidance. There were three dominant factors that influenced decision making processes: 1) Exclusive breastfeeding was not the cultural norm, therefore practising it raised questions within the family and community about a mother's parenting capabilities and HIV status. 2) Women living with HIV lacked autonomy in decision-making on infant feeding due to socio-cultural factors. 3) Non-disclosure of HIV status to close members due to the stigma. CONCLUSION Infant feeding decision-making by women living with HIV in rural Kenya is constrained by a lack of autonomy, stigma and poverty. There is an urgent need to address these challenges through scaling up psycho-social and gender empowerment strategies for women, and introducing initiatives that promote the integration of HIV infant feeding strategies into other child health services.
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Affiliation(s)
- Helen M. Nabwera
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Joyline Jepkosgei
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Kelly W. Muraya
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
| | - Amin S. Hassan
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Catherine S. Molyneux
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Rehema Ali
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Andrew M. Prentice
- MRC Unit, The Gambia, PO Box 273, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - James A. Berkley
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Martha K. Mwangome
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
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16
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Flax VL, Yourkavitch J, Okello ES, Kadzandira J, Katahoire AR, Munthali AC. "If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing": The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda. PLoS One 2017; 12:e0178298. [PMID: 28594842 PMCID: PMC5464556 DOI: 10.1371/journal.pone.0178298] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 05/10/2017] [Indexed: 11/18/2022] Open
Abstract
The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands' decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, Ministries of Health should use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.
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Affiliation(s)
- Valerie L. Flax
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- * E-mail:
| | - Jennifer Yourkavitch
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
- ICF, Fairfax, Virginia, United States of America
| | - Elialilia S. Okello
- Department of Psychiatry, Makerere University, Kampala, Uganda
- Centre for Child Health and Development, Makerere University, Kampala, Uganda
| | - John Kadzandira
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
| | | | - Alister C. Munthali
- Centre for Social Research, Chancellor College, University of Malawi, Zomba, Malawi
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17
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Ashaba S, Kaida A, Burns BF, O'Neil K, Dunkley E, Psaros C, Kastner J, Tsai AC, Bangsberg DR, Matthews LT. Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda. BMC Pregnancy Childbirth 2017; 17:138. [PMID: 28482821 PMCID: PMC5423027 DOI: 10.1186/s12884-017-1321-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2017] [Indexed: 01/03/2023] Open
Abstract
Background In sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women. Methods We conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis. Results Twenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm3 (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality. Conclusions The results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1321-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Kasey O'Neil
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jasmine Kastner
- Research Institute McGill University Health Centre Montreal, Montreal, Canada
| | - Alexander C Tsai
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David R Bangsberg
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lynn T Matthews
- MGH Global Health, Massachusetts General Hospital, Boston, MA, USA.,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Flax VL, Hamela G, Mofolo I, Hosseinipour MC, Hoffman IF, Maman S. Factors influencing postnatal Option B+ participation and breastfeeding duration among HIV-positive women in Lilongwe District, Malawi: A qualitative study. PLoS One 2017; 12:e0175590. [PMID: 28410374 PMCID: PMC5391929 DOI: 10.1371/journal.pone.0175590] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022] Open
Abstract
To ensure the health of mothers and children, prevention of mother-to-child HIV transmission (PMTCT) programs test women for HIV, engage HIV-positive women in care, and promote recommended breastfeeding practices. Under Malawi's Option B+ PMTCT program, ~20% of women are lost-to-follow-up (LTFU) and little is known about their breastfeeding practices. The purpose of this study is to describe facilitators and barriers to Option B+ participation and how participation influences breastfeeding duration. We conducted in-depth interviews with HIV-positive women in Option B+ (n = 32) or LTFU from Option B+ (n = 32). They were recruited from four government clinics in Lilongwe District and had a child aged 0-23 months. Women in Option B+ had better disclosure experiences and more social support than LTFU women. The most common reasons for LTFU were fear of HIV disclosure, anticipated or experienced stigma, and insufficient social support. Other reasons included: non-acceptance of HIV status, antiretroviral therapy (ART) side effects, lack of funds for transport, and negative experiences with clinic staff. Worries about possible transmission, even while on ART, influenced timing of weaning for some women in Option B+. Despite their knowledge of the risk of HIV transmission to the child, most LTFU women continued to breastfeed after stopping ART because they considered breastmilk to be an important source of nutrients for the child. Given that HIV-positive Malawian women LTFU from Option B+ breastfeed in the absence of ART, efforts are needed to use evidence-based strategies to address the barriers to Option B+ participation and avert preventable transmission through breastmilk.
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Affiliation(s)
- Valerie L. Flax
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- RTI International, Research Triangle Park, North Carolina, United States of America
| | | | | | - Mina C. Hosseinipour
- UNC Project – Malawi, Lilongwe, Malawi
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Irving F. Hoffman
- UNC Project – Malawi, Lilongwe, Malawi
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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19
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Schnack A, Rempis E, Decker S, Braun V, Rubaihayo J, Busingye P, Tumwesigye NM, Harms G, Theuring S. Prevention of Mother-to-Child Transmission of HIV in Option B+ Era: Uptake and Adherence During Pregnancy in Western Uganda. AIDS Patient Care STDS 2016; 30:110-8. [PMID: 27308804 DOI: 10.1089/apc.2015.0318] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Since 2012, lifelong antiretroviral therapy for all HIV-positive pregnant women ("Option B+") is recommended by WHO for the prevention of mother-to-child transmission of HIV (PMTCT). Many sub-Saharan African countries have since introduced this regimen, but to date, longer-term outcome evaluations are scarce. We conducted an observational study in Fort Portal Municipality, Uganda, to describe uptake and adherence of Option B+ during pregnancy. HIV-positive women approaching antenatal care (ANC) services in two hospitals were enrolled and followed-up at monthly routine ANC visits until delivery. At each visit, next to sociodemographic and clinical data, we assessed drug adherence through pill counts. In total, 124 HIV-positive pregnant women were enrolled in our study; from these, 80.8% had not been aware of their positive serostatus before. Forty-five PMTCT clients (36.3%) never returned to ANC after their first visit. Protective factors (p < 0.05) for immediate loss to care included previous HIV status knowledge, status disclosure before or at first ANC visit, and tertiary education. Among those clients starting Option B+, the median adherence during pregnancy was 95.7% pill intake. Rather low adherence (<80%) was observed in 21.1% of clients, while more than half achieved an adherence level of ≥95%, with 40.8% of all clients being 100% adherent. The cohort's median adherence remained stable throughout the course of pregnancy. Healthcare providers should place high emphasis on individual PMTCT counseling at first ANC encounter, and pay special attention to those women previously unaware of their HIV status. However, after initial uptake, high adherence seems to be feasible for Option B+.
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Affiliation(s)
- Alexandra Schnack
- Institute of Tropical Medicine and International Health, Charité–University Medicine Berlin, Berlin, Germany
| | - Eva Rempis
- Institute of Tropical Medicine and International Health, Charité–University Medicine Berlin, Berlin, Germany
| | - Sarah Decker
- Institute of Tropical Medicine and International Health, Charité–University Medicine Berlin, Berlin, Germany
| | - Vera Braun
- Institute of Tropical Medicine and International Health, Charité–University Medicine Berlin, Berlin, Germany
| | - John Rubaihayo
- Public Health Department, Mountains of the Moon University, Fort Portal, Uganda
| | | | | | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité–University Medicine Berlin, Berlin, Germany
| | - Stefanie Theuring
- Institute of Tropical Medicine and International Health, Charité–University Medicine Berlin, Berlin, Germany
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