Citation
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: PMC6686681Abstract
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.
URL
http://dx.doi.org/10.1097/QAI.0000000000000263Reference Type
Journal ArticleYear Published
2014Journal Title
Journal of Acquired Immune Deficiency SyndromesAuthor(s)
Clouse, KateSchwartz, Sheree R.
Van Rie, Annelies T.
Bassett, Jean F.
Yende, Nompumelelo
Pettifor, Audrey E.