Maternal priorities for preventive therapy among HIV‐positive pregnant women before and after delivery in South Africa: a best–worst scaling survey

Abstract

IntroductionPregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery. We quantified changes in priorities related to isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) among pregnant women living with HIV.MethodsWe enrolled pregnant women recently diagnosed with HIV from 14 primary health clinics during pregnancy and followed them after delivery in Matlosana, South Africa. Best–worst scaling (BWS) was used to determine the women's priorities out of 11 attributes related to preventive therapy in the ante‐ versus postpartum periods. Aggregate BWS scores were calculated based on the frequency with which participants selected each attribute as the best or worst among five options (across multiple choice sets). Individual BWS scores were also calculated and rescaled from 0 (always selected as worst) to 10 (always selected as best), and changes in BWS scores in the ante‐ versus postpartum periods were compared, using a paired t‐test. Factors associated with the changes in BWS scores were examined in multiple linear regressions. Spearman's rho was used to compare the ranking of attributes.ResultsOut of a total of 204 participants, 154 (75.5%) completed the survey in the postpartum at the median 15 (IQR: 11 to 27) weeks after delivery. Trust in healthcare providers was most highly prioritized both in the ante‐ (individual BWS Score = 7.34, SE = 0.13) and postpartum periods (BWS = 7.21 ± 0.11), followed by living a long life (BWS = 6.77 ± 0.09 in the ante‐ vs. BWS = 6.86 ± 0.10 in the postpartum). Prevention for infants’ health was more prioritized in the post‐ (BWS = 6.54 ± 0.09) versus antepartum periods (BWS = 6.11 ± 0.10) (p = 0.05). This change was associated with IPT initiation at enrolment (regression coefficient = 0.78 ± 0.33, p = 0.001). Difficulty in daily pill‐uptake was significantly more prioritized in the postpartum (BWS = 5.03 ± 0.11) than in the antepartum (BWS = 4.43 ± 0.10) (p < 0.01). Transportation cost and worry about side effects of pills were least prioritized. Overall ranking of attributes was similar in both time periods (spearman's rho = 0.90).ConclusionsComprehensive interventions to build trust in healthcare providers and support adherence may increase uptake of preventive therapy. Counselling needs to emphasize medication benefits for both maternal and infant health among HIV‐positive pregnant women.

Eliciting Preferences for HIV Prevention Technologies: A Systematic Review

“…The most common preference elicitation methods used were DCE (28, 33%), CA (21, 25%), WTA (18, 21%), and WTP [including CV] (15, 18%). Only two used BWS [ 23 , 24 ], and no other preference elicitation methods were found. The oldest article was from 1998; it used WTA and WTP direct elicitations to examine women’s preferences for vaginal antimicrobial (sexually transmitted infection [STI]/HIV) contraceptives [ 25 ].…”

“…The two BWS studies used different types of analyses. Kim et al reported relative and mean BWS scores, paired t-tests, and linear regression [ 23 ]. Newman et al used multinomial logit and rank-exploded logit.…”

“…There were five studies that considered PMTCT; two of these evaluated product and service design attributes, one willingness. Two investigated motivations to seek PMTCT services [ 23 , 27 , 42 , 48 , 100 ].…”

Migration and first-year maternal mortality among HIV-positive postpartum women: A population-based longitudinal study in rural South Africa

“…Mothers living with HIV often take ART to prevent HIV transmission to their infants at birth but may stop seeking care after safely delivering their babies [6,39]. Postpartum mothers, who already face the challenges of looking after a new baby, face a double burden by migrating [40] and being more likely to disengage from care and be lost to follow-up [4][5][6][7][8], putting them at heightened risk of adverse health outcomes.…”

Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment

“…Second, we did not directly ask about the benefits of preventing HIV transmission to infants, which could be the most important concern for mothers. Preventing HIV transmission to partners may pose similar social responsibility, and factors related to infants were tested in another discrete choice experiment and presented elsewhere (42) (43). Third, the an objective measure of selfreported adherence to ART, such as viral load suppression, was not available.…”