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

Abstract

Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions.

“What Will I Be Doing There Among So Many Women?”: Perceptions on Male Support in Prevention of Mother to Child Services in Lilongwe, Malawi

“…A recent study done in Kenya reported that men are at times unaware of PMTCT services, yet their understanding is the platform for rendering support to a partner. 27 Spousal support and disclosure of an HIV status is influenced by the strength of the relationship with solid relationships creating a safe environment for disclosure. 27 Women are key in spousal support, because in some instances, women do not want their partners accompanying them for PMTCT services, which hinders male involvement.…”

Towards a definition of male partner involvement in the prevention of mother-to-child transmission of HIV in Uganda: a pragmatic grounded theory approach

“…While the item (iv) The man supports his partner’s antenatal visits financially corresponds to ‘Economic support’. In Kenya, [20] a previous study defined male partner involvement as both active and passive. Active involvement could include attending ANC/PMTCT appointments at the clinic with his partner.…”

“…In the framework of prevention of mother-to-child transmission (PMTCT), male partner involvement is usually aimed at the health needs of the mother and infant, such as support for mothers’ antenatal HIV testing, uptake of Nevirapine, and formula-feeding or exclusive breastfeeding [14, 16]. Studies have suggested ways to define male partner involvement (MI) and its determinants in a PMTCT setting [17–20]. However, the descriptions focus on clinic attendance and couple counselling and testing [21–23], and in other instances, remain indefinite and vary within different populations and contexts.…”

‘We are the advocates for the babies’ - understanding interactions between patients and health care providers during the prevention of mother-to-child transmission of HIV in South Africa: a qualitative study

“…Based on the findings of our study and other studies [35][36][37][38] we therefore emphasize the need for a multi-level intervention targeted at improving working conditions and reducing health system deficiencies to promote HCP professional development and quality of patient care. To improve professionalization of HCPs, we recommend training on personalised, culturally and contextually appropriate care [39,40], which can be included in university curricula for medical and nursing students and in the regular in-service training for HCPs. A more personalised approach to PMTCT and maternity care will make HCPs not only an advocate for babies, but also an advocate for mothers.…”