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A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV
Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well de...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021710/ https://www.ncbi.nlm.nih.gov/pubmed/36962063 http://dx.doi.org/10.1371/journal.pgph.0000004 |
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author | Humphrey, John Alera, Marsha Kipchumba, Bett Pfeiffer, Elizabeth J. Songok, Julia Mwangi, Winfred Musick, Beverly Yiannoutsos, Constantin Wachira, Juddy Wools-Kaloustian, Kara |
author_facet | Humphrey, John Alera, Marsha Kipchumba, Bett Pfeiffer, Elizabeth J. Songok, Julia Mwangi, Winfred Musick, Beverly Yiannoutsos, Constantin Wachira, Juddy Wools-Kaloustian, Kara |
author_sort | Humphrey, John |
collection | PubMed |
description | Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well described. We explored these factors within an enhanced sub-cohort of the East Africa International Epidemiology Databases to Evaluate AIDS Consortium. From 2018–2019, a purposeful sample of PPHIV ≥18 years of age were recruited from five maternal and child health clinics providing integrated PMTCT services in Kenya. Women retained in care were recruited at the facility; women who had become LTFU (last visit >90 days) were recruited through community tracking. Interview transcripts were analyzed thematically using a social-ecological framework. Forty-one PPHIV were interviewed. The median age was 27 years, 71% were pregnant, and 39% had become LTFU. In the individual domain, prior PMTCT experience and desires to safeguard infants’ health enhanced retention but were offset by perceived lack of value in PMTCT services following infants’ immunizations. In the peer/family domain, male-partner financial and motivational support enhanced retention. In the community/society domain, some women perceived social pressure to attend clinic while others perceived pressure to utilize traditional birth attendants. In the healthcare environment, long queues and negative provider attitudes were prominent barriers. HIV-related stigma and fear of disclosure crossed multiple domains, particularly for LTFU women, and were driven by perceptions of HIV as a fatal disease and fear of partner abandonment and abuse. Both retained and LTFU women perceived that integrated HIV services increased the risk of disclosure. Retention was influenced by multiple factors for PPHIV. Stigma and fear of disclosure were prominent barriers for LTFU women. Multicomponent interventions and refining the structure and efficiency of PMTCT services may enhance retention for PPHIV. |
format | Online Article Text |
id | pubmed-10021710 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-100217102023-03-17 A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV Humphrey, John Alera, Marsha Kipchumba, Bett Pfeiffer, Elizabeth J. Songok, Julia Mwangi, Winfred Musick, Beverly Yiannoutsos, Constantin Wachira, Juddy Wools-Kaloustian, Kara PLOS Glob Public Health Research Article Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well described. We explored these factors within an enhanced sub-cohort of the East Africa International Epidemiology Databases to Evaluate AIDS Consortium. From 2018–2019, a purposeful sample of PPHIV ≥18 years of age were recruited from five maternal and child health clinics providing integrated PMTCT services in Kenya. Women retained in care were recruited at the facility; women who had become LTFU (last visit >90 days) were recruited through community tracking. Interview transcripts were analyzed thematically using a social-ecological framework. Forty-one PPHIV were interviewed. The median age was 27 years, 71% were pregnant, and 39% had become LTFU. In the individual domain, prior PMTCT experience and desires to safeguard infants’ health enhanced retention but were offset by perceived lack of value in PMTCT services following infants’ immunizations. In the peer/family domain, male-partner financial and motivational support enhanced retention. In the community/society domain, some women perceived social pressure to attend clinic while others perceived pressure to utilize traditional birth attendants. In the healthcare environment, long queues and negative provider attitudes were prominent barriers. HIV-related stigma and fear of disclosure crossed multiple domains, particularly for LTFU women, and were driven by perceptions of HIV as a fatal disease and fear of partner abandonment and abuse. Both retained and LTFU women perceived that integrated HIV services increased the risk of disclosure. Retention was influenced by multiple factors for PPHIV. Stigma and fear of disclosure were prominent barriers for LTFU women. Multicomponent interventions and refining the structure and efficiency of PMTCT services may enhance retention for PPHIV. Public Library of Science 2021-10-13 /pmc/articles/PMC10021710/ /pubmed/36962063 http://dx.doi.org/10.1371/journal.pgph.0000004 Text en © 2021 Humphrey et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Humphrey, John Alera, Marsha Kipchumba, Bett Pfeiffer, Elizabeth J. Songok, Julia Mwangi, Winfred Musick, Beverly Yiannoutsos, Constantin Wachira, Juddy Wools-Kaloustian, Kara A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV |
title | A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV |
title_full | A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV |
title_fullStr | A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV |
title_full_unstemmed | A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV |
title_short | A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV |
title_sort | qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with hiv |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021710/ https://www.ncbi.nlm.nih.gov/pubmed/36962063 http://dx.doi.org/10.1371/journal.pgph.0000004 |
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