A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV

dc.contributor.authorHumphrey, John
dc.contributor.authorAlera, Marsha
dc.contributor.authorKipchumba, Bett
dc.contributor.authorPfeiffer, Elizabeth J.
dc.contributor.authorSongok, Julia
dc.contributor.authorMwangi, Winfred
dc.contributor.authorMusick, Beverly
dc.contributor.authorYiannoutsos, Constantin
dc.contributor.authorWachira, Juddy
dc.contributor.authorWools-Kaloustian, Kara
dc.contributor.departmentMedicine, School of Medicine
dc.date.accessioned2023-11-15T14:46:19Z
dc.date.available2023-11-15T14:46:19Z
dc.date.issued2021-10-13
dc.description.abstractRetention 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.
dc.eprint.versionFinal published version
dc.identifier.citationHumphrey J, Alera M, Kipchumba B, et al. A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV. PLOS Glob Public Health. 2021;1(10):e0000004. Published 2021 Oct 13. doi:10.1371/journal.pgph.0000004
dc.identifier.urihttps://hdl.handle.net/1805/37056
dc.language.isoen_US
dc.publisherPublic Library of Science
dc.relation.isversionof10.1371/journal.pgph.0000004
dc.relation.journalPLoS Global Health
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourcePMC
dc.subjectHIV
dc.subjectRetention in care
dc.subjectPregnancy
dc.subjectMother-to-child HIV transmission
dc.titleA qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV
dc.typeArticle
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