HIV-positive women's experiences of a PMTCT programme in rural Malawi

Objective

to explore women's experiences of a prevention of mother-to-child transmission (PMTCT) programme in rural Malawi.

Design, setting and participants

an exploratory, qualitative study using in-depth interviews with 24 purposively selected women infected with human immunodeficiency virus (HIV). The women were in three groups of eight: (1) those who delivered at the hospital and took nevirapine (NVP) before birth and whose babies received NVP within 72 hours of birth; (2) those who birthed at home and took NVP before birth but their babies never received NVP; and (3) those who birthed at home and did not take NVP and whose babies did not receive NVP. Data were analysed using content analysis.

Findings

four themes emerged: (1) ‘a wish to confirm and protect’ refers to women's decisions to take the HIV test, (2) ‘a revelation for action’ is an illustration of how the testing may be part of an empowering process, (3) ‘a dilemma between silence and openness’ points to the dilemma that women are facing in their decision to share or not to share their HIV status with spouse, family, friends and community, and (4) ‘a desire challenged by circumstances, chance and tradition’ refers to the circumstances and actions which prevent these women from actually delivering at the hospital to protect their babies from HIV infection.

Conclusions

the PMTCT programme influences women's lives profoundly, and the importance of quality counselling and strengthening male involvement is stressed as the programme is implemented by an increasing number of service providers.     

Voluntary counselling and testing (VCT) for Human Immunodeficiency Virus: a study on acceptability by Nigerian women attending antenatal clinics

This study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options. Majority of the women (89.9%) had good knowledge of the modes of HIV transmission, however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives. Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. As the country is about to embark on its PMTTCT programme, there is need to increase the level of knowledge, acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries. Innovative information and education techniques need to be developed to provide HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options and other forms of care.     

Male involvement in maternity health care in Malawi

This study was conducted in Mwanza district in southern Malawi with the aim of investigating the individual's, community's and health workers' perception of male involvement in maternal health care. In-depth interviews and focus group discussions were the methods used for data collection. The participants' responses generated two main themes namely male involvement in health facility care and outside the health facility. The participants' perception of male involvement in facility care concentrated around six sub-themes describing male involvement as; couple HIV counselling and testing; a government law; a strategy for fast services for women; unfair programme for women without partners; a foreign concept; an act of love. We conclude that male involvement in the health facility care was fragmented and associated mainly with first antenatal care; couple HIV counselling and testing; suggesting poor integration of male involvement into the existing maternal and child health programmes and that there is need to engender maternal health care services.     

Primiparous mothers' knowledge about mother-to-child transmission of HIV in Lusaka, Zambia

Objective

to learn what primiparous mothers in Lusaka, Zambia know about human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), mother-to-child transmission (MTCT) of HIV, and breast feeding.

Design

qualitative interviews analysed by thematic manifest content analysis.

Setting

postnatal wards at Lusaka University Teaching Hospital.

Participants

14 primiparous mothers were interviewed.

Findings

1 year after implementation of the prevention of MTCT programme in Zambia, the majority of the women interviewed lacked basic knowledge about MTCT. They did not know that HIV is present in breast milk and that it is a source of transmission. Few mothers had been informed about breast feeding, correct attachment and ways of avoiding breast infection. The mothers seemed to be uncertain about what HIV actually is, and they preferred to talk about MTCT and safe breast feeding rather than HIV/AIDS in general, which was the main reason for their participation in the study. According to the mothers, the most effective way of preventing transmission of HIV to the unborn baby was a single dose of nevirapine. Many believed that treatment is equal to cure and gives the baby full protection. The overall feeling of mothers was that they had not received information and support from the antenatal clinics and postnatal wards. The more traditional women preferred not to discuss these issues with their friends, their husbands or their families, which may make it more difficult to spread information and encourage couples to make decisions about their and their baby's future.

Conclusion

these findings suggest that primiparous mothers and their families need more education about MTCT of HIV. The mothers also need basic education about breast feeding and how to avoid breast injuries. The main reason for mothers’ poor knowledge may be that health workers do not have the necessary information. There seems to be a need for training in breast-feeding and baby-feeding counselling in the context of HIV in order to promote exclusive and safe breast feeding. As such, further research about health workers’ knowledge and methods of teaching is required.     

KAP Study on HIV/AIDS Among Antenatal Women Attending Central Referral Hospital of North East India

Background

This study was conducted to determine whether antenatal mothers in Sikkim have adequate knowledge about awareness, attitude, and preventive practices regarding HIV infection.

Methods

Cross-sectional study using structured questionnaire. 220 Antenatal mothers attending the outpatient department of Central Referral Hospital of Sikkim were taken for the study for a period of 1 year from April 2011 to April 2012. Questionnaire form filled by pregnant women during their first antenatal visit was the source of data for this study. Systematic sampling technique was used where every alternate pregnant women registering for ANC visit were voluntarily recruited into the study.

Results

2.27 % (5) women had not heard about HIV. 84 % (38) women had the knowledge that HIV was related to STI, while 50 % (110) did not. Television was the best method of increasing the knowledge (48 %). 68 % (150) of the women were aware about mother-to-child transmission (MTCT) of HIV during antenatal period. Only 2.66 % (6) women knew that HIV can be transmitted to child through breast milk. 90 % (198) knew that HIV is spread by having unsafe sex, 48 % (106) women knew using condoms would protect against it. 69.4 % (153) women wanted partner testing, and 84 % (185) of women consented that all pregnant women should be tested for HIV.

Conclusions

The current study revealed high levels of knowledge, positive attitude, and preventive practices regarding HIV; however, this population lacked knowledge about MTCT and its prevention.

     

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

Women in sub-Saharan Africa are increasingly learning their HIV status in prevention of mother-to-child transmission of HIV (PMTCT) programmes in the context of antenatal care. This paper examines women's decisions about HIV testing and their experience of PMTCT and HIV-related care in one clinic in Lilongwe, Malawi. It is based on qualitative, ethnographic research conducted in 2004 and 2005, including interviews and focus group discussions with 55 HIV-positive women participating in a PMTCT programme, and 21 interviews with key informants from the programme and the health system. Women's expectations from testing were consistent with the benefits for their own health and their infants' health, as communicated by nurses. However, the PMTCT programme only poorly met their expectations. Reasons for this disjuncture included the construction of women as still healthy even when they needed treatment, a focus only on infant health, health system weaknesses, lack of integrated care and timely referral, and defining HIV exclusively as a medical issue, while ignoring the social determinants of health. Women's own health was particularly marginalised within the PMTCT programme, yet good models exist for comprehensive care for women, infants and their families that should be implemented as testing is scaled up.     

Women's Attitudes Toward Their Partners’ Involvement in Antenatal Care and Prevention of Mother‐to‐Child Transmission of HIV in Cameroon,Africa

Introduction : Although the HIV epidemic has stabilized worldwide, it remains a public health challenge in sub‐Saharan Africa. The key strategy to prevention and control of HIV remains voluntary counseling and testing. In sub‐Saharan Africa, 76% of pregnant women have at least one antenatal visit. Therefore, antenatal care is a venue through which women can access HIV testing, and, if infected, obtain care for prevention of mother‐to‐child transmission (PMTCT). Public health organizations have promoted increasing HIV testing of men by incorporating partner testing into antenatal care. Recent studies have shown that African women may not be receptive to their partner's involvement in obstetric care secondary to cultural attitudes and traditional beliefs. Methods : A quality improvement project surveyed women to identify their attitudes and beliefs concerning antenatal care, PMTCT, and partner's participation in antenatal care and testing. Results : Women viewed antenatal care as important to having a positive pregnancy outcome and the primary venue through which they accessed HIV testing. Most women (83.8%) were receptive to their partners’ involvement in antenatal care and identified increased partner participation over the past 5 years. Women (98.2%) said men's primary role was payment for obstetric care. Cultural and gender‐based attitudes and beliefs were identified as barriers to HIV testing of men. Discussion : Women viewed antenatal care as important to a positive pregnancy outcome with access dependent on their families’ finances and their partners’ ability and willingness to pay for their care. Although pregnancy has traditionally been viewed as a women's affair, the majority of women wanted their partners to participate in their care, including receiving HIV counseling and testing. Women identified men's involvement as an individual belief, saying that many in their community were not supportive of male participation in antenatal care. Multiple options, including couples testing in antenatal clinics, should be available to increase HIV testing in men.     

Prevention of mother to child transmission of HIV: Our experience in South India

Objectives

To determine the outcomes of various ARV (Anti-Retroviral) prophylactic regimes given to HIV positive pregnant mothers, based on time of presentation, for prevention of vertical transmission.

Methods

During a four year period, 92 pregnant HIV positive women and their newborn infants received various ARV prophylactic regimes for prevention of vertical transmission. The outcome, in terms of presence of HIV infection in the infants born to these mothers was studied.

Results

The prevalence of HIV infection in the antenatal group studied was 0.62%. Of the 92 HIV positive pregnant mothers who delivered live babies, 91.3% received ARV prophylaxis or HAART, and 95.6% of the 92 live infants received ARV prophylaxis. The risk of vertical transmission was only 3.3%.

Conclusions

Judicious PMTCT regimes, even if they appear complex, are possible in the Indian setting, and can result in significant decline of HIV positive children. Duration of treatment and mode of delivery should be based on the time of presentation of the HIV positive pregnant mother.     

Analysis of the Prevention of Mother-to-Child Transmission (PMTCT) Service utilization in Ethiopia: 2006-2010

Introduction  

Although progressive improvements have been made in the coverage and quality of prevention of HIV/AIDS mother-to-child transmission (PMTCT) services in Ethiopia, the national coverage remained persistently low. Analysis of the cascaded PMTCT services can reveal the advancements made and the biggest hurdles faced during implementation.     

Rates of HBV,HCV, HDV and HIV type 1 among pregnant women and HIV type 1 drug resistance-associated mutations in breastfeeding women on antiretroviral therapy

Background

HBV, HCV, HDV and HIV are blood borne and can be transmitted from mother-to-child. Reports of HBV infection rates show up to 11.9% in Cameroon while for HCV, the rate is less than 2%. More so, as pregnant women get enrolled in the HIV PMTCT Programme and stay in the care continuum, selection of HIV-1 drug resistant strains is evident. We sought to determine the seroprevalence of HBV, HCV, HDV and HIV among pregnant women, assess their knowledge, attitudes and practices on transmission and prevention of HBV infection, and determine HIV drug resistance profile of breastfeeding women.

Methods

A serosurvey of HBV, HCV, HDV and HIV was carried out among 1005 pregnant women in Yaounde, Cameroon. In 40 HIV-infected breastfeeding women enrolled in the PMTCT Programme, HIV-1 genotypes and HIV-1 resistance to NRTIs, NNRTIs and PIs, were determined by phylogeny and the Stanford University HIV Drug Resistance interpretation tool, respectively.

Results

Among the pregnant women, the rates of HIV-1, HBV, HCV and HDV infections were 8.5, 6.4, 0.8 and 4.0%, respectively. About 5.9% of the women knew their HBV status before pregnancy unlike 63.7% who knew their HIV status. Although 83.3% reported that vaccination against HBV infection is a method of prevention, and 47.1% knew that HBV could be transmitted from mother-to-child, only 2.5% had received the Hepatitis B vaccine. Of the 40 women on antiretroviral therapy (ART), 9 had at least one major resistance-associated mutation (RAM, 22.5%) to NRTI, NNRTI or PI. Of these M184?V (12.5%), K70R (10.0%), K103?N (12.5%), Y181C (10.0%), M46?L (2.5%) and L90?M (2.5%) were most frequently identified, suggesting resistance to lamivudine, nevirapine, efavirenz and zidovudine. Eighty four percent were infected with HIV-1 recombinant strains with CRF02_AG predominating (50%).

Conclusions

The rates of HBV and HIV-1 infections point to the need for early diagnosis of these viruses during pregnancy and referral to care services in order to minimize the risk of MTCT. Furthermore, our results would be useful for evaluating the HIV PMTCT Programme and Treatment Guidelines for Cameroon.

     

Unknown Antenatal HIV-Infection Status Has Declined Over Time in British Columbia,Canada

Objectives

The objective was to determine whether the proportion of pregnant women with unknown antenatal HIV-infection status is declining over time in British Columbia (BC) and whether associated factors are amenable to intervention.

Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa

In Africa, a large proportion of HIV infections occur within stable relationships, either because of prior infection of one of the partners or because of infidelity. In five African countries at least two-thirds of couples with at least one HIV-positive partner were HIV serodiscordant; in half of them, the woman was the HIV-positive partner. Hence, there is an urgent need to define strategies to prevent HIV transmission within couple relationships. HIV counselling and testing have largely been organised on an individual and sex-specific basis, for pregnant women in programmes for prevention of mother-to-child transmission of HIV and in STI consultations and recently male circumcision for men. A couple-centred approach to HIV counselling and testing would facilitate communication about HIV status and adoption of preventive behaviours within couples. This paper reviews what is known about HIV serodiscordance in heterosexual couples in sub-Saharan Africa and what has been published about couple-centred initiatives for HIV counselling and testing since the early 1990s. Despite positive outcomes, couple-oriented programmes have not been implemented on a large scale. In order to stimulate and strengthen HIV prevention efforts, increased attention is required to promote prevention and testing and counselling for couples in stable relationships.     

Five years of parent-to-child transmission of HIV-AIDS program in a rural-based teaching hospital

Objectives

To reduce the perinatal transmission of HIV AIDS in antenatal women—a need-based project with NACO protocols, with a series of interventions.

Methods

Prospective and retrospective study, data collected from Parent-to-Child Transmission of HIVAIDS records and case sheets. Women registered for pretest counseling in antenatal OP tested for HIV, posttest counseling given, single drug NVP administered to mother and neonate, exclusive breast feeding advised for first 6 months, and infant testing for HIV done at 18 months of age by ELISA.

Results

Seroprevalence in antenatal women was 1.2%. Majority (95%) of mother-child pairs were administered single drug NVP. Institutional delivery rate for seropositive women was 70% and the perinatal transmission of HIV AIDS was 8%.

Conclusion

Improve universal counseling and testing, more number of mother-baby pairs to be administered single drug NVP, increase institutional delivery rates for seropositive women, improve follow-up services with the help of outreach workers to reduce perinatal transmission of HIV AIDS.     

Factors influencing HIV screening decisions for pregnant migrant women in South East Asia

Background

universal screening in pregnancy for HIV is common and migrant women are an identified high risk group. The increasing mobility within countries and migration across borders affects the growing prevalence of HIV, but little is understood about how migrant women view risk of HIV in relation to pregnancy.

Objectives

to explore factors that relate to HIV screening decisions for migrant women.

Design

the HIV antenatal counselling experiences of pregnant migrant women were explored in a Grounded Theory study.

Settings

the four settings were antenatal care units of border hospitals in northern Thailand

Participants

38 migrant pregnant women who had been through the HIV screening process at participating antenatal clinics as well as 26 health personnel at the units were purposively recruited and interviewed about their experiences and attitudes to HIV counselling and testing for this group.

Methods

in-depth interviews were conducted from January to March 2008. The grounded theory technique of open coding was employed and constant comparison took place throughout until saturation was achieved.

Findings

four themes were identified as common to the women and the health professionals: ineffective provision of information; internal and external barriers to information; implications of migrant status; and perception of risk.

Conclusions

where language barriers exist interpreters are required and creative approaches to information giving that do not rely on text are necessary. The organisation of clinics does not currently meet the needs of migrant women and causes stress for health staff due to time constraints. Extra resources should be focussed where there are large numbers of migrants.     

The prevention of mother-to-child HIV transmission programme in Lilongwe,Malawi: why do so many women drop out

Mother-to-child transmission of HIV constitutes a substantial burden of new HIV infections in sub-Saharan Africa, and losses to follow-up continue to undermine prevention of mother-to-child transmission of HIV (PMTCT) programmes. This qualitative study sought to clarify why some women who were enrolled in a PMTCT programme in Lilongwe, Malawi, did not fully participate in follow-up visits in the first six months after testing HIV-positive. Twenty-eight women, 14 who participated fully in the programme and 14 who dropped out, were purposively selected for in-depth interview at two clinics. Focus group discussions with 15 previously interviewed and 13 newly recruited women were also conducted. Discussions with 12 of the women's husbands were also carried out. Although the proportion of women being tested has reportedly increased, losses to follow-up have shifted and are occurring at every step after testing. Major emerging themes associated with dropping out of the PMTCT programme within six months after delivery were to avoid involuntary HIV disclosure and negative community reactions, unequal gender relations, difficulties accessing care and treatment, and lack of support from husbands. The whole approach to the delivery of the PMTCT programme and home visits must be reconsidered, to improve confidentiality and minimise stigmatization. Women need to be empowered economically and supported to access HIV treatment and care with their partners, to benefit their whole family.     

Predictors of unknown HIV serostatus at the time of labor and delivery in Kampala,Uganda

Objective

To determine factors associated with an unknown HIV serostatus among pregnant women admitted in labor to Mulago Hospital, Kampala, Uganda.

Methods

In total, 665 pregnant women admitted to Mulago Hospital were interviewed about their sociodemographic characteristics, obstetric history, access to prenatal care, fears regarding HIV testing, and knowledge about modes of mother-to-child-transmission (MTCT). Knowledge of the HIV serostatus was assessed by self-report and verified by prenatal card review.

Results

The prevalence of unknown HIV serostatus at the time of labor was 27.1%. Factors associated with an unknown HIV serostatus included high parity (odds ratio [OR] 1.9; 95% confidence interval [CI], 1.16–3.14), preterm delivery (OR 2.60; 95% CI, 1.06–6.34), prenatal care at a private clinic (OR 12.87; 95% CI, 5.68–29.14), residence more than 5 km from the nearest prenatal clinic (OR 2.86; 95% CI, 1.18–17.9), high knowledge about MTCT (OR 0.25; 95% CI, 0.07–0.86), and fears related to disclosing the test result to the partner (OR 3.60; 95% CI, 1.84–7.06).

Conclusion

The high prevalence of unknown HIV serostatus among women in labor highlights the need to improve accessibility to HIV testing services early during pregnancy to be able to take advantage of antiretroviral therapy.     

Barriers to Men's Participation in Antenatal and Prevention of Mother‐to‐Child HIV Transmission Care in Cameroon,Africa

Introduction : Men's role in HIV prevention is pivotal to changing the course of the epidemic. When men participate in Prevention of Mother‐to‐Child Transmission (PMTCT) programs, their knowledge of HIV increases, their behavior becomes supportive, and their receptiveness to HIV testing increases. In Cameroon, Africa, multiple efforts have been implemented that encourage men to “follow” their wives to obstetric/PMTCT care and to undergo HIV testing. However, only 18% of men have participated in this care. Methods : As a quality improvement initiative, a survey was administered to identify men's knowledge and attitudes regarding antenatal care (ANC), PMTCT, and HIV. The survey consisted of a questionnaire with an emphasis on identifying barriers to men's participation in PMTCT programs and obtaining HIV testing. A convenience sampling method was used, and no participant identifying information was collected. Results : Men's participation in ANC/PMTCT is affected by sociocultural barriers centered in tribal beliefs and traditional gender roles. The barriers identified included the belief that pregnancy is a “woman's affair”; the belief that a man's role is primarily to provide financial support for the woman's care; the man's perception that he will be viewed as jealous by the community if he comes to clinic with his pregnant wife; and cultural gender‐based patterns of communication. Discussion : Most men consider accompanying their wife to ANC/PMTCT a good practice. Yet fewer men actually do this, because they feel that the provision of finance for ANC registration and delivery fees is their most important role in supporting their wife's pregnancy. Health care workers should encourage individuals and community leaders to build upon the traditional value of financial responsibility, expanding a man's involvement to include supportive social roles in obstetric care, PMTCT, and HIV testing. J Midwifery Womens Health 2010;55:363–369     

Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother-to-child transmission of HIV in the Dominican Republic

ObjectiveTo investigate whether costs of multidose antiretroviral regimens (MD-ARVs), including highly active antiretroviral therapy (HAART), for prevention of mother-to-child transmission (PMTCT) of HIV might be offset by savings gained from treating fewer perinatally acquired infections.MethodsRates of MTCT reported in the Dominican Republic among mother-infant pairs treated with single-dose nevirapine (SD-NVP; n = 39) and MD-ARVs (n = 91) for PMTCT were compared. Annual births to women infected with HIV were estimated from seroprevalence studies. Antiretroviral costs for both PMTCT and for HAART during the first 2 years of life (in cases of perinatal infection) were based on 2008 low-income country price estimates.ResultsRates of MTCT were 3.3% and 15.4% for the MD-ARV and SD-NVP groups, respectively (P = 0.02). Assuming that 5775 of 231 000 annual births (2.5%) were to HIV-positive women, it was estimated that 191 perinatally acquired infections would occur using MD-ARVs and 889 using SD-NVP. High costs of maternal MD-ARVs (HAART, US$914,760 versus SD-NVP, $1155) would be offset by lower 2-year HAART costs ($250,344 versus $1,168,272 for infants in the SD-NVP group) for the lower number of children with prenatally acquired infection (191 versus 889) associated with the use of MD-ARVs for PMTCT (net national saving $3168).ConclusionDespite the high costs, use of MD-ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.