Barriers associated with the utilization of continued care among HIV-infected women who had previously enrolled in a private sector PMTCT program in Maharashtra, India

Abstract

Prevention of mother-to-child transmission (PMTCT) programs are considered as an entry point to continued care because they provide an opportunity to link an HIV-infected woman, her partner, and child(ren) (if infected) to long-term treatment and care. However, little is known about the factors associated with the utilization of continued care among women who have previously accessed PMTCT services. Better knowledge of the barriers to continued care in HIV-infected women could lead to effective strategies to increase the uptake of post-PMTCT care. This study was designed to examine the factors associated with the utilization of continued care among HIV-infected women enrolled in the PRAYAS PMTCT program in Maharashtra, India, between 2002 and 2011. All consenting women who had completed the receipt of PMTCT services or who were lost to follow-up at least six months prior to the time of data collection were interviewed. Univariate and multivariate analyses were conducted to estimate the associations between not utilizing continued care and hypothesized risk factors using generalized linear models. Of the 688 eligible HIV-positive women, 311 completed a structured interview. Since their exit from the PMTCT program, 59 (19%) had never utilized HIV-related care, 58 (19%) had intermittently utilized HIV-related care, and 194 (62%) had consistently utilized HIV-related care at regular intervals. After adjusting for potential confounders, women with poor HIV-related knowledge (relative risk [RR] = 1.83; 95% CI: 1.15-2.92), women whose partners had never utilized HIV-related care (RR = 4.82; 95% CI: 2.57-9.04), and women who could not afford to travel to the HIV-care facility (RR = 2.36; 95% CI: 1.23-4.53) were less likely to utilize HIV-related care after exiting the PMTCT program. This study highlights the need for enhanced techniques to impart HIV and antiretroviral therapy-related knowledge and underlines the need for improved partner involvement and financial support for travel to HIV facility to increase the uptake of post-PMTCT treatment and care.

Retention and mortality outcomes from a community‐supported public–private HIV treatment programme in Myanmar

“…Second, there are valid questions regarding sustainability of this model. One of the concerns regarding access to treatment in the private sector is out-of-pocket regimen costs [39] that can interfere with continuity of care [9], frequency of clinical monitoring visits [15], regimen choice [40], ART adherence [40] and, ultimately, viral suppression [41,42]. In our partnership model, there were no out-of-pocket payments made by patients as all their diagnostic and clinical care costs were covered through the partnership.…”

“…Providing HIV care to the general public through the private sector is an approach adopted elsewhere [7] and is becoming increasingly relevant given the rising patient volume at public health services in many low- and middle-income countries [8]. Although precise figures are lacking, evidence suggests that a growing number of people in South Africa, India, Namibia, Papua New Guinea and Tanzania are already accessing ART through private providers [9–13]. In Myanmar, non-governmental organizations and the private sector contribute 50% of current ART coverage [2].…”

Feasibility of supervised self‐testing using an oral fluid‐based HIV rapid testing method: a cross‐sectional, mixed method study among pregnant women in rural India

“…In India, these include low awareness of HIV testing services, poor understanding of ways to prevent mother-to-child transmission of HIV, poor perception of HIV risk, social and cultural barriers (such as low partner support), and fear of stigma and discrimination following disclosure [5,6]. Access to HIV testing and retention in care is further obstructed by factors related to the Indian health system, such as a lack of trained healthcare workers for antenatal HIV counselling [6], long distances to HIV testing facilities, especially in rural areas [7,8], and inequalities in antenatal care coverage and attendance [9]. …”

Outcomes of HIV treatment from the private sector in low-income and middle-income countries: a systematic review protocol

“…Faced with overburdened public health systems, there is an increasing interest in the role that private providers could play in the delivery of ART in LMIC. Evidence suggests that a large number of people in countries such as South Africa, India, Namibia, Papua New Guinea and Tanzania are accessing ART through private providers 19–23. However, the concept of private providers in healthcare is not new, nor is it confined to ART.…”

“…These concerns are amplified by an ongoing ideological dilemma regarding the extent to which the private sector should be leveraged to provide ART, when the primary responsibility of providing universal healthcare rests with governments 17 18. A large number of people in countries such as South Africa, India, Namibia, Papua New Guinea and Tanzania are accessing ART through private providers 19–23. Yet searches of Embase, Cochrane Library and PubMed databases suggest that there is limited literature describing pooled outcomes of ART delivered by the private sector in LMIC.…”