Barriers to maternal retention in HIV care in Ghana: key differences during pregnancy and the postpartum period

Abstract

Background: Maternal retention in HIV care is lower for women in the postpartum period than during pregnancy, but the reasons are poorly understood. We examined key differences in barriers to retention in HIV care during and after pregnancy. Methods: We conducted semi-structured, in-depth interviews with 30 postpartum women living with HIV. Participants were recruited from two tertiary facilities implementing Option B+ for prevention of mother-to-child HIV transmission in Accra, Ghana. We collected data from mothers who had disengaged from HIV care and those who were still engaged in care. The interviews were analyzed using principles adapted from grounded theory. Results: Participants' experiences and narratives showed that retention in HIV care was more challenging during the postpartum period than during pregnancy. Poor maternal physical health (from birth complications and cesarean section), socio-cultural factors (norms about newborn health and pregnancy), and economic difficulties linked to childbirth (such as unemployment, under-employment, and debt) made the costs of retention in HIV care more economically and socially expensive in the postpartum period than during pregnancy. Some participants also shared that transportation costs and resulting dependence on a partner to pay increased during the postpartum period because of a strong shift in maternal preference for private modes of transportation due to HIV stigma and the desire to protect the newborn. These factors played a larger role in the postpartum period than during pregnancy and created a significant barrier to retention. A conceptual model of how these factors interrelate, the synergy between them, and how they affect retention in the postpartum period is presented. Conclusions: In Ghana, lower retention in HIV care in the postpartum period compared to in pregnancy may be primarily driven by social, economic, and newborn health factors. Multifaceted economic-based and stigmareduction interventions are needed to increase retention in maternal HIV care after childbirth.

HIV and malaria prevalence among pregnant women with and without pre‐eclampsia at the Atua Government Hospital in Ghana’s eastern region

“…This is because the information was not readily available in the medical records retrieved. Ghana has an active HIV program with HAART as an integral component of the mother‐to‐child Transmission Prevention Program implemented among pregnant women 25 . However, some challenges hamper the proper intake of HAART among pregnant women, including reported adverse effects of antiretroviral drugs, lifestyle behaviors, and HIV stigma, among others 26…”

The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis

“…Previous studies indicate that PLHIV commonly confronts various distress and unmet medical care needs 4 5. Moreover, the issue of HIV-related discrimination also acts as a barrier to PLHIV seeking medical and psychosocial support 6 7. Therefore, more medical care resources, especially those that can lower PLHIV’s psychological defences, are needed to improve PLHIV’s quality of life, thus promoting the achievement of the ‘95-95-95’ goal (95% of PLHIV know their HIV infection, 95% of PLHIV with HIV-positive diagnosis receive ART, 95% of PLHIV on ART achieve viral load suppression)8 and improving health-related quality of life for PLHIV at any stage 9…”

“If I don’t take my treatment, I will die and who will take care of my child?”: An investigation into an inclusive community-led approach to addressing the barriers to HIV treatment adherence by postpartum women living with HIV

“…Sakyi et al … found that the increased tendency of postpartum mothers to be lost to HIV care was due to two factors: the experiences of poverty and HIV stigma [ 8 ]. This is confirmed by systematic reviews and meta-analyses of the many studies of pregnant and postpartum women living with HIV [ 9 ].…”