Pregnant and Postpartum Women’s Experiences and Perspectives on the Acceptability and Feasibility of Copackaged Medicine for Antenatal Care and PMTCT in Lesotho

Abstract

Objective. To improve PMTCT and antenatal care-related service delivery, a pack with centrally prepackaged medicine was rolled out to all pregnant women in Lesotho in 2011. This study assessed acceptability and feasibility of this copackaging mechanism for drug delivery among pregnant and postpartum women. Methods. Acceptability and feasibility were assessed in a mixed method, cross-sectional study through structured interviews (SI) and semistructured interviews (SSI) conducted in 2012 and 2013. Results. 290 HIV-negative women and 437 HIV-positive women (n = 727) participated. Nearly all SI participants found prepackaged medicines acceptable, though modifications such as size reduction of the pack were suggested. Positive experiences included that the pack helped women take pills as instructed and contents promoted healthy pregnancies. Negative experiences included inadvertent pregnancy disclosure and discomfort carrying the pack in communities. Implementation was also feasible; 85.2% of SI participants reported adequate counseling time, though 37.8% felt pack use caused clinic delays. SSI participants reported improvement in service quality following pack introduction, due to more comprehensive counseling. Conclusions. A prepackaged drug delivery mechanism for ANC/PMTCT medicines was acceptable and feasible. Findings support continued use of this approach in Lesotho with improved design modifications to reflect the current PMTCT program of lifelong treatment for all HIV-positive pregnant women.

Factors Contributing to the Late Commencement of Antenatal Care at a Rural District Hospital in Lesotho

“…In rural parts of Lesotho, even educated women still recognize the significant position of husbands and their notable leadership role in family related decisions (Gill et al, 2015). The education disparity between the high and low lands districts of Lesotho reveals the variance between Thaba-tseka district (highlands) in which 29% of women have obtained minimum secondary education contrary to 61% seen in the Lowland district of Berea (Gill et al, 2015). "We are mountainous people, so we are not well informed on a number of issues as a result we lack adequate knowledge.…”

“…The reproductive health care corners for younger mother are intended to offer a range of sexual and reproductive health care needs including; antenatal care services offered to the adolescents through education, and counseling programs. The unique facilities offer needed privacy to younger women, who usually do not feel comfortable to receive joint services with older clientele (Gill et al, 2015;Matobo, Makatsa, & Obioha, 2009). Certain cultural myths, including witchcraft within the Basotho culture are quite influential in delaying commencement of antenatal care on time.…”

“…The young married couple usually resides at the groom's patriarchal home under the parents' authority. This arrangement becomes even more evident, where a young man is sometimes compelled to seek employment in the lowlands of Lesotho or even to the neighboring South Africa (Matobo, et al, 2009;Gill et al, 2015). The remaining mother, has to plan her needs around the routine of her in-laws.…”

“…The extensive routine including normal home chores of cleaning, washing and cooking for the extended family and even farming related duties can be quite daunting for the pregnant young woman making it difficult to find time to attend antenatal care. The complicated extended family setting, compels the pregnant woman to seek consent from the husband or in-laws to commence antenatal care (Gill et al, 2015).…”