Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya

Abstract

Background As prevention of mother-to-child transmission of HIV (PMTCT) programs and HIV treatment programs rapidly expand in parallel, it is important to determine factors that influence the transition of HIV-infected women from maternal to continuing care. Design This study aimed to determine rates and co-factors of accessing HIV care by HIV-infected women exiting maternal care. A cross-sectional survey of women who had participated in a PMTCT research study and were referred to care programs in Nairobi, Kenya was conducted. Methods A median of 17 months following referral, women were located by peer counselors and interviewed to determine whether they accessed HIV care and what influenced their care decisions. Fisher’s exact test was used to assess the association between client characteristics and access to care. Results Peer counselors traced 195 (82%) residences, where they located 116 (59%) participants who provided information on care. Since exit, 50% of participants had changed residence, and 74% reported going to the referral HIV program. Reasons for not accessing care included lack of money, confidentiality, and dislike of the facility. Women who did not access care were less likely to have informed their partner of the referral (p=0.001), and were less likely believe that highly active antiretroviral therapy (HAART) is effective (p<0.01). Among those who accessed care, 33% subsequently discontinued care, most because they did not qualify for HAART. Factors cited as barriers to access included stigma, denial, poor services, and lack of money. Factors that were cited as making care attractive included health education, counseling, free services, and compassion. Conclusion A substantial number of women exiting maternal care do not transit to HIV care programs. Partner involvement, a standardized referral process and more comprehensive HIV education for mothers diagnosed with HIV during pregnancy may facilitate successful transitions between PMTCT and HIV care programs.

The Role of Maternal, Health System, and Psychosocial Factors in Prevention of Mother-to-Child Transmission Failure in the Era of Programmatic Scale Up in Western Kenya: A Case Control Study

“…21 They may also have additional challenges to taking the ART medications as prescribed, especially if health care workers manage them in the same way that they manage women who were diagnosed with HIV before pregnancy. 22 Increased counseling may provide these women with the psychosocial support required to navigate these barriers and equip them with information about ART and the need for adherence.…”

Barriers to Care, and Current Medical and Social Needs of HIV-Positive Patients in Albania

“…However, it is not possible to distinguish these unmet needs from those of the general population, but patients with HIV may be more burdened by these needs because of their medical conditions. Previous studies in developing countries have shown that similar barriers to care along with medical and social needs exist and pose an obstacle that must be overcome to achieve necessary coverage of HIV/AIDS medical treatment (26)(27)(28)(29)(30)(31)(32). However, what is unique amongst the Albanian population relative to other Central European countries seems to be the generalized widespread unmet social needs.…”

“…These barriers can be rooted within the population or healthcare sector and have dramatic effects on treatment and prevention of HIV/AIDS (26). Fear of social stigma, limited knowledge of HIV/AIDS by both healthcare providers and the general population, and inability to locate proper care are common barriers in resource-limited countries (27)(28)(29)(30)(31)(32). Patients that fail to navigate these barriers may not get the care they need.…”

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

“…The only quantitative study exploring risk factors for loss to follow-up among HIV-infected women who were enrolled in a PMTCT program in India has identified woman's education level and her family's economic status as major risk factors for loss to follow-up (Panditrao, Darak, Kulkarni, Kulkarni, & Parchure, 2011). Doubts about antiretroviral therapy (ART) as an effective treatment for HIV or faith in traditional medicine to treat their HIV infection have been reported by women who did not seek treatment from ART centers in Kenya and South Africa (Otieno et al, 2010;Population Council, 2009).…”