Factors Enhancing Utilization of and Adherence to Prevention of Mother-to-Child Transmission (PMTCT) Service in an Urban Setting in Kenya

Abstract

Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing to high numbers of children living with HIV globally and is among the 22 PMTCT global plan priority countries. Using structured and in-depth interviews this study examined enabling factors that enhance utilization of and adherence to PMTCT services in an urban setting in Kenya. HIV-positive birthmothers (N = 55) whose infants were HIV-negative at the time of the study completed a structured interview and a subset (n = 15) participated in in-depth interviews. The majority of the mothers (98 %) delivered at a health facility and 91 % exclusively breastfed. Further, 91 % attended clinic appointments regularly and 69.1 % strictly adhered to prescribed medication dosage and schedules. However, 18 % had not disclosed their HIV status to anybody, 27 % did not use condom during sex, 95 % did not participate in AIDS support groups and 53 % of their male partners were not involved in PMTCT. Four key themes facilitating PMTCT success emerged from the qualitative data: supportive counseling, striving for motherhood, assurance of confidentiality; and confirmation, affirmation and admiration. HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to reach out for support from family and community, apply acquired knowledge and access more affordable care. To be successful, PMTCT programs should be aware of these factors and ensure that mothers are provided with culturally competent care.

Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care

“…Many distinct factors contributed to how a woman assessed her individual circumstances and overcame barriers to engage in care and follow PMTCT guidelines. Consistent with previous studies, our findings suggest that uptake of PMTCT services can be facilitated by accurate knowledge and understanding of HIV and PMTCT [ 8 – 10 ], positive disclosure experiences, especially with a male partner who knows his own status, and active support from both the community and male partners [ 24 ]. Our study also found that male partners had a significant influence on women’s participation in PMTCT [ 6 , 7 , 9 , 10 ].…”

“…Prior studies on attrition from PMTCT programs in African settings have primarily gathered data from HIV-positive women only, and identified discrete factors that influence their participation in PMTCT services. Commonly cited barriers include stigma associated with HIV [ 6 – 9 ], limited understanding of PMTCT [ 8 – 10 ], fear of disclosure and lack of support from male partners [ 6 , 7 , 9 , 10 ], and dissatisfaction with clinic programs, staff, and confidentiality [ 6 , 8 , 10 ]. There has been less in-depth analysis on the complex relationships between these barriers, and how external influences, including the community, male partners, and healthcare workers, contribute toward a woman’s decisions regarding enrollment and participation in PMTCT services.…”

Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda

“…This is related to what has been documented in a previous study that knowing someone who is living with HIV enables those infected to accept their HIV status because of the inner comfort they feel knowing that someone shares their experience [25, 68]. This finding echoes earlier work showing that peer support groups play an important role in helping women living with HIV to understand HIV and PMTCT programs leading to retention in care and adherence to ART [69–72]. On the other hand participants in our study did not feel comfortable disclosing their status to community members for fear of stigma and ridicule contrary to what has been reported in a previous study that community members play a role in helping WLWH adhere to their medication and cope with the illness [70].…”

What influences feeding decisions for HIV-exposed infants in rural Kenya?

“…Our findings therefore highlight the need for health care workers to utilize a more empathic approach to the issue of non-adherence in their prevention of vertical transmission counseling sessions, recognising the positive intentions and psychological stress that HIV infected mothers undergo in making infant feeding choices. Ultimately this approach may also help to promote adherence to recommended practices [62]. …”