TITLE:
Patient-Reported Factors Facilitating Participation in Prevention of Mother to Child Transmission of HIV Programs in Kara, Togo, West Africa
AUTHORS:
Eméfah C. Loccoh, Deladem Azouma, Kevin Fiori Jr., Jennifer Schechter, Sesso Gbeleou, Lisa R. Hirschhorn
KEYWORDS:
Maternal Health, Program Adherence, AIDS, Mother-to-Child Transmission, HIV Positive Women
JOURNAL NAME:
World Journal of AIDS,
Vol.4 No.4,
December
29,
2014
ABSTRACT: Background: Despite efforts to expand
prevention of mother-to-child transmission (PMTCT) of HIV in resource-limited
settings, only 53% of women in sub-Saharan Africa receive adequate PMTCT
services. Understanding factors that enable successful program completion are
crucial to improving adherence rates to PMTCT programs in these settings. Using
a positive deviance approach, we explored patient and provider’s perspectives
on factors enabling women to successfully access and adhere to PMTCT services
to identify areas of program improvement and further reduce HIV transmission.
Methods: Semi-structured interviews were conducted with 11 health care workers
(HCWs) at two health centers in Kara, Togo and 34 women who had successfully
completed the PMTCT program at those facilities. Women were identified using
purposive sampling and content theme analysis was used to analyze the data.
Results: Knowledge and belief in the potential to give birth to an HIV-negative
child, supported by facilitating factors on the individual and community
levels, was the cornerstone to women’s PMTCT program success. Effective program
education and peer-to-peer interactions fostered the participants’ knowledge
and belief in PMTCT, with the resulting internal motivation driving continued
participation and adherence. The welcoming environment, availability of peer
support groups and financial assistance from the health facility, further
facilitated success, with women using this facility-based community to seek
advice and support from HCWs and peers. Financial, physical, and emotional
support from relatives was also important in ensuring unhindered access.
Finally, the faith-based communities’ acceptance and support for HIV-positive
women further encouraged participants to adhere to the program. Conclusion:
Understanding and believing in the ability to have an HIV-negative baby was the
most important facilitator for PMTCT program adherence. This led to internal
motivation that was continually reinforced through facility and community supportive
environments focused on addressing barriers. Efforts to improve PMTCT success
should focus on all of these factors through a patient-centered approach.