Interactions among Poverty, Gender, and Health Systems Affect Women’s Participation in Services to Prevent HIV Transmission from Mother to Child: A Causal Loop Analysis

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Citation

Yourkavitch, Jennifer; Hassmiller Lich, Kristen; Flax, Valerie L.; Okello, Elialilia S.; Kadzandira, John; Katahoire, Anne Ruhweza; Munthali, Alister C.; & Thomas, James C. (2018). Interactions among Poverty, Gender, and Health Systems Affect Women's Participation in Services to Prevent HIV Transmission from Mother to Child: A Causal Loop Analysis. PLOS ONE, 13(5), e0197239. PMCID: PMC5959065

Abstract

Retention in care remains an important issue for prevention of mother-to-child transmission (PMTCT) programs according to WHO guidelines, formerly called the "Option B+" approach. The objective of this study was to examine how poverty, gender, and health system factors interact to influence women's participation in PMTCT services. We used qualitative research, literature, and hypothesized variable connections to diagram causes and effects in causal loop models. We found that many factors, including antiretroviral therapy (ART) use, service design and quality, stigma, disclosure, spouse/partner influence, decision-making autonomy, and knowledge about PMTCT, influence psychosocial health, which in turn affects women's participation in PMTCT services. Thus, interventions to improve psychosocial health need to address many factors to be successful. We also found that the design of PMTCT services, a modifiable factor, is important because it affects several other factors. We identified 66 feedback loops that may contribute to policy resistance-that is, a policy's failure to have its intended effect. Our findings point to the need for a multipronged intervention to encourage women's continued participation in PMTCT services and for longitudinal research to quantify and test our causal loop model.

URL

http://dx.doi.org/10.1371/journal.pone.0197239

Reference Type

Journal Article

Year Published

2018

Journal Title

PLOS ONE

Author(s)

Yourkavitch, Jennifer
Hassmiller Lich, Kristen
Flax, Valerie L.
Okello, Elialilia S.
Kadzandira, John
Katahoire, Anne Ruhweza
Munthali, Alister C.
Thomas, James C.

PMCID

PMC5959065

ORCiD

Thomas, JC - 0000-0002-2225-2052
Flax - 0000-0003-0200-3355
Hassmiller Lich - 0000-0002-3311-4202