An exploration of barriers and enablers of retention in a program to reduce vertical transmission of HIV at health centers in Zimbabwe

Abstract

Background: Poor retention in the prevention of women in prevention of vertical transmission programs remains a formidable common setback in elimination of HIV/AIDS. It creates new problems such as poor health outcomes and increased incidence of vertical transmission of HIV. There is a dearth of qualitative information to explain poor retention of women in prevention of mother-to-child transmission (PMTCT) programs in Zimbabwe. The purpose of the study was to explore the enablers and barriers of retention of women in PMTCT programs. Methods: This was a basic qualitative study conducted at four health centers in Zimbabwe. Four audiotaped focus group discussions were conducted with 34 pregnant or breastfeeding women coming for PMTCT services at the health centers. Descriptive statistics was used for sample demographics. Transcripts were analyzed through latent content analysis based on the Graneheim and Lundman method. Results: Maternal determination, a four-tier support system, and an inspiring health package were enablers to retention in the PMTCT program while uninspired individual engagement, paternalism, and undesirable PMTCT-related events were barriers to retention of women in the PMTCT program. Conclusions: Reinforcing hope for the women and their children, active management of side effects of antiretroviral medicine, consistent peer support, enhancing confidentiality among community cadres, and commitment from community or religious leaders may improve retention of women in PMTCT programs; for women with HIV during pregnancy, delivery and post-natal care.

Perceptions and Experiences of Participating in PMTCT Option B Plus: An Explorative Study on HIV-positive Pregnant Women in Eswatini

“…The participants commended the positive attitude of the HCWs, which facilitated a good provider-patient relationship, helped them to cope with the HIV-positive test results, and encouraged their continued participation in PMTCT. Similar observations were found in other studies as well [19,28,29]. The study found that the integration of PMTCT with other antenatal services helped to minimise the stigma associated with living with HIV.…”

“…The positive perception about PMTCT served as a motivation for them to enroll in PMTCT. In this study and prior studies in SSA, the drive to enroll in PMTCT arose from the mother's desire to protect their babies from HIV infection [7,19,20,34,48]. The women enrolled in PMTCT understood that they could prevent HIV from transmitting from the mother to the baby by taking and adhering to ART.…”

Effect of peer-mother interactive programme on prevention of mother-to-child HIV transmission outcomes among pregnant women on anti-retroviral treatment in routine healthcare in Dar es Salaam, Tanzania

“…Peer support services have been widely in use to mitigate barriers of uptake, adherence and outcomes in HIV and PMTCT services in low-and middle-income countries [10][11][12]. The motivation for peer support services has been partly driven by challenges of human resource shortages in understaffed overburdened health care systems, and also the demand for counselling, adherence and psychosocial support among women receiving PMTCT care [10,[13][14][15][16][17]. Although there is rich qualitative literature on the engagement of peer-mothers in PMTCT care [14,[18][19][20], the literature remains scarce on quantitative evaluation of the effect of peermothers on PMTCT outcomes, specifically ART adherence and retention, viral suppression and MTCT, in the era of lifelong ART for PMTCT [10][11][12]21].…”

A Landscape Analysis of Prevention of Vertical Transmission Program Data and Interventions From Fiscal Years 2019–2021

“…10 Prohibitive financial requirements for clinical visits and nutritional needs while on ART along with drug-related side effects can pose further challenges. 12 In the face of these barriers, ensuring continuity of care for MIPs in countries with high rates of vertical transmission requires prioritized engagement of MIPs until cessation of breastfeeding, so they may receive the full package of prophylaxis and support services and timely infant HIV testing in line with WHO guidelines. Without such continuity in care, infants with HIV remain undiagnosed and untreated with resulting high rates of mortality: 12% of infants living with HIV will die by age 2 to 3 months, 35% by 1 year and 52% by the age of 2 years.…”