A Qualitative Analysis of the Barriers and Facilitators to Receiving Care in a Prevention of Mother-to-Child Program in Nkhoma, Malawi

Ngozi D. Iroezi, Deborah Mindry, Paul Kawale, Grace Chikowi, Perry A. Jansen, Risa M. Hoffman

Abstract

Prior to 2011, uptake of PMTCT in Malawi remained low despite increased access to antiretrovirals. We sought to understand barriers to PMTCT in rural Malawi. Twenty-two HIV-infected pregnant and postpartum women in PMTCT programs were interviewed in Nkhoma, Malawi, between April-May 2010. All women were staged by WHO criteria or CD4 count as ineligible for three-drug treatment by Malawi’s HIV Guidelines at the time. The median age was 26 years (range 22-39) and 77% were married. Barriers to accessing PMTCT care included transportation to clinic, stigma in the community leading to avoidance of HIV disclosure, food insecurity, and providers’ attitudes towards HIV-infected pregnant women. Given Malawi’s transition to Option B+ for PMTCT in which women are initiated on antiretroviral therapy (ART) during pregnancy and continued for life, strategies to improve access and retention will need to address barriers and incorporate facilitators that motivate and retain women in HIV care. Afr J Reprod Health 2013 (Special Edition); 17[4]: 118-129).

 

Keywords:  HIV/AIDS, Malawi, maternal health, prevention of mother-to-child transmission

 

Résumé

 

Avant 2011, l'adoption de la PTME au Malawi est restée faible malgré un accès accru aux antirétroviraux. Nous avons cherché à comprendre les obstacles à la PTME dans les régions rurales du Malawi. Vingt-deux femmes enceintes et les femmes du postpartum qui sont infectées par le VIH et qui suivaient  les programmes de PTME ont été interrogées à Nkhoma,  Malawi, entre avril et mai 2010. Toutes les femmes ont été mises en scène par des critères de l’OMS ou des CD4 qui comptent comme inéligible pour un traitement de trois médicaments par les lignes directrices du VIH au Malawi à l'époque. L'âge médian était de 26 ans (extrêmes: 22-39) et 77 % étaient mariés. Les obstacles à l'accès aux soins de la PTME comprennent  le transport à la clinique,  la stigmatisation dans la communauté, ce qui  mène à l'évitement de la divulgation, l'insécurité alimentaire et les attitudes des prestataires envers les femmes enceintes infectées par le VIH. Compte tenu de la transition du Malawi vers l'Option B + de la PTME dans laquelle les femmes sont initiées à la thérapie antirétrovirale (ART) au cours de la grossesse et qui continué à vie, il faudra que des stratégies pour améliorer l'accès et la rétention  surmontent les obstacles et à intégrer les animateurs qui motivent et retiennent les femmes en matière de soins du VIH. Afr J Reprod Health 2013 (Edition Spéciale); 17[4]: 118-129).

 

Mots-clés: VIH/SIDA,  Malawi,  santé maternelle,  prévention de la transmission  de la mère à l’enfantPrior to 2011, uptake of PMTCT in Malawi remained low despite increased access to antiretrovirals. We sought to understand barriers to PMTCT in rural Malawi. Twenty-two HIV-infected pregnant and postpartum women in PMTCT programs were interviewed in Nkhoma, Malawi, between April-May 2010. All women were staged by WHO criteria or CD4 count as ineligible for three-drug treatment by Malawi’s HIV Guidelines at the time. The median age was 26 years (range 22-39) and 77% were married. Barriers to accessing PMTCT care included transportation to clinic, stigma in the community leading to avoidance of HIV disclosure, food insecurity, and providers’ attitudes towards HIV-infected pregnant women. Given Malawi’s transition to Option B+ for PMTCT in which women are initiated on antiretroviral therapy (ART) during pregnancy and continued for life, strategies to improve access and retention will need to address barriers and incorporate facilitators that motivate and retain women in HIV care. Afr J Reprod Health 2013 (Special Edition); 17[4]: 118-129).  Keywords:  HIV/AIDS, Malawi, maternal health, prevention of mother-to-child transmission  Résumé  Avant 2011, l'adoption de la PTME au Malawi est restée faible malgré un accès accru aux antirétroviraux. Nous avons cherché à comprendre les obstacles à la PTME dans les régions rurales du Malawi. Vingt-deux femmes enceintes et les femmes du postpartum qui sont infectées par le VIH et qui suivaient  les programmes de PTME ont été interrogées à Nkhoma,  Malawi, entre avril et mai 2010. Toutes les femmes ont été mises en scène par des critères de l’OMS ou des CD4 qui comptent comme inéligible pour un traitement de trois médicaments par les lignes directrices du VIH au Malawi à l'époque. L'âge médian était de 26 ans (extrêmes: 22-39) et 77 % étaient mariés. Les obstacles à l'accès aux soins de la PTME comprennent  le transport à la clinique,  la stigmatisation dans la communauté, ce qui  mène à l'évitement de la divulgation, l'insécurité alimentaire et les attitudes des prestataires envers les femmes enceintes infectées par le VIH. Compte tenu de la transition du Malawi vers l'Option B + de la PTME dans laquelle les femmes sont initiées à la thérapie antirétrovirale (ART) au cours de la grossesse et qui continué à vie, il faudra que des stratégies pour améliorer l'accès et la rétention  surmontent les obstacles et à intégrer les animateurs qui motivent et retiennent les femmes en matière de soins du VIH. Afr J Reprod Health 2013 (Edition Spéciale); 17[4]: 118-129).  Mots-clés: VIH/SIDA,  Malawi,  santé maternelle,  prévention de la transmission  de la mère à l’enfant

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