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“What They Wanted Was to Give Birth; Nothing Else”: Barriers to Retention in Option B+ HIV Care among Postpartum Women in South Africa


Clouse, Kate; Schwartz, Sheree R.; Van Rie, Annelies T.; Bassett, Jean F.; Yende, Nompumelelo; & Pettifor, Audrey E. (2014). "What They Wanted Was to Give Birth; Nothing Else": Barriers to Retention in Option B+ HIV Care among Postpartum Women in South Africa. Journal of Acquired Immune Deficiency Syndromes, 67(1), e12-8. PMCID: PMC6686681


BACKGROUND: Women initiating antiretroviral therapy (ART) during pregnancy have high rates of drop-out, particularly after delivery. We aimed to identify challenges to postpartum retention in care under Option B+, which expands ART access to all HIV-positive pregnant women regardless of CD4 count.
METHODOLOGY: We performed two semi-structured interviews (SSI, n=50) and one focus group discussion (FGD, n=8) with HIV-positive women at Witkoppen Health and Welfare Centre, a primary care facility in Johannesburg, South Africa, that is one of the only clinics offering Option B+ in South Africa.
RESULTS: Fifty women completed the SSI before delivery, and 48 (96%) completed the second SSI within 3 months of delivery. Median age was 28 years (IQR: 26-34), most women worked (62%) or had worked in the prior year (18%). Postpartum women attending HIV care perceived that barriers to HIV-care post-delivery among other women included the belief that mothers care more about the baby's health than their own (29.2%, 14/48women were "ignorant" or "irresponsible" (16.7%, 8/48negative clinic staff treatment (12.5%, 6/48and denial or lack of disclosure of HIV status (10.4% each, 5/48Experienced barriers included lack of money (18.0%, 9/50), work conflict (6.0%, 3/50) and negative staff treatment (6.0%, 3/50). During the FGD, three main themes emerged: conflict with work commitment, negative treatment from health care workers and lack of disclosure related to stigma.
CONCLUSIONS: We identified a complex set of interconnected barriers to retaining postpartum women in HIV care under Option B+, including structural, personal and societal barriers. The importance of postpartum HIV care for the mother's own health must be embraced by health care workers and public health programs.


Reference Type

Journal Article

Year Published


Journal Title

Journal of Acquired Immune Deficiency Syndromes


Clouse, Kate
Schwartz, Sheree R.
Van Rie, Annelies T.
Bassett, Jean F.
Yende, Nompumelelo
Pettifor, Audrey E.