Why do women not return for CD4 count results at Embhuleni Hospital, Mpumalanga, South Africa?

Abstract

BackgroundAccording to the South African Policy and guidelines for the implementation of the PMTCT programme of 2008, all pregnant women who tested HIV-positive also had to have their CD4 count measured in order to inform the option of Prevention of Mother-to-Child Treatment (PMTCT): to be put on lifelong treatment or to be placed on temporary PMTCT. They were required to return for the results within two weeks, but some did not return, implying that they did not benefit from the programme. This study was conducted to establish their reasons for not returning.ObjectivesTo explore the reasons given by women attending antenatal care for not returning for the results of their CD4 count done for PMTCT at Embhuleni Hospital and satellite clinics, Mpumalanga.MethodsThe study was a qualitative study using the free-attitude interview technique. Women who had not returned for their results were traced and interviewed on their reasons for not returning. Interviews were conducted in Siswati, audio-taped, transcribed verbatim and translated into English for analysis. Data saturation was reached by the eighth participant. A thematic analysis was conducted.ResultsThe themes that emerged were: participants were not informed about the PMTCT process; poor service delivery from the healthcare practitioners; unprofessional healthcare practitioners’ conduct; shortages of medication in the healthcare facilities; fear of social stigma; and poor patient socioeconomic conditions.ConclusionThe reasons for not returning were mainly based on participants’ experiences during consultations at the healthcare centres and their perceptions of the healthcare practitioners. Healthcare practitioners should adhere to the tenets of professionalism in order to address this problem.

Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya

“…We observed that involuntary HIV status disclosure related to participation in HIV care was the most common social concern among pregnant women in our study. In line with our results, previous qualitative studies from SSA and Asia have reported that concern about unintentional HIV status disclosure has been identified as a barrier to visiting PMTCT care facilities [13][14][15][16][17][18]. Concern about involuntary HIV disclosure has been suggested to limit access to care by promoting fear and isolation among pregnant women in Kenya [13].…”

“…PMTCT care as well as ART to prevent sexual transmission, condom use, and voluntary male medical circumcision are successful strategies for HIV prevention in low and middle-income countries [2,3,12]. However, qualitative evidence from sub-Saharan Africa (SSA) and Asia has shown that concerns about unintentional HIV status disclosure and HIV related stigma are barriers to participate in PMTCT care among pregnant women [13][14][15][16][17][18]. Qualitative studies have also identified other important barriers to HIV status disclosure including concerns about separation or divorce [19][20][21][22][23], conflicts with a partner [19,21], intimate partner violence (IPV) [19][20][21]23] and stigma in the family or community [20,23].…”

‘We have goals but [it is difficult]’. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa

“…Fear of unintended HIV status disclosure and its repercussion when attending clinic appointments deters health‐seeking behaviour. Often people living with HIV fear attending local community healthcare facilities and will sometimes choose to attend clinics that are far from their local facilities to avoid being recognized 53,54 . Also, harsh treatment from clinic staff and stigmatizing language often lead to a feeling of moral failing and shame, resulting in treatment interruption.…”

“…Often people living with HIV fear attending local community healthcare facilities and will sometimes choose to attend clinics that are far from their local facilities to avoid being recognized. 53 , 54 Also, harsh treatment from clinic staff and stigmatizing language often lead to a feeling of moral failing and shame, resulting in treatment interruption. Incorporating facility‐wide stigma‐reduction strategies in staff training and health programmes would foster improved patient–clinic staff relationships.…”