All Title Author
Keywords Abstract

A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia

DOI: 10.1155/2012/532154

Full-Text   Cite this paper   Add to My Lib


Objectives. Despite the availability of services to prevent mother-to-child transmission (PMTCT) of HIV, socio-cultural, health system and operational factors constrain many pregnant women from accessing services or returning for followup thereby increasing the risk of vertical transmission of HIV to newborns. We highlight and describe unique contextual factors contributing to low utilization of PMTCT services in Arba-Minch, Ethiopia. Methods. Qualitative research design was utilized to obtain data through focus group discussions and in-depth interviews with antenatal clinic attendees, health workers health facilities in the study area. Results. Awareness of PMTCT services and knowledge of its benefits was nearly universal, although socioeconomic, cultural and health system factors, including stigma and desire to prevent knowledge of serostatus, impede access to and utilization of services. Health system factors—lack of appropriate followup mechanisms, inadequate access to ARV drugs and poorly equipped manpower also contribute to low utilization of services. Conclusion. Reducing mother-to-child transmission of HIV in sub-Saharan Africa will be more effective when unique contextual factors are identified and addressed. Effectiveness of PMTCT interventions rests on a well functioning health system that recognize the importance of social, economic, cultural contexts that HIV positive pregnant women live in. 1. Background In 2009, the United Nations AIDS Program (UNAIDS) reported that 430,000 of the approximately 2.5 million children under the age of 15 living with HIV were newly infected, the majority in sub-Saharan Africa [1]. Many of these children acquired the infection from their mothers during pregnancy, birth, or breastfeeding. Timely administration of antiretroviral drugs to a HIV-positive pregnant woman and her newborn child significantly reduces the risk of mother-to-child transmission [2]. Now recognized as an attainable public health strategy, preventing mother-to-child transmission (PMTCT) has four basic components: (i) prevention of primary infection among women, (ii) prevention of unintended pregnancies among HIV positive women, (iii) provision of specific interventions to reduce the risk of mother-to-child transmission, and (iv) provision of care, treatment and support to HIV infected women, their infants and families [3, 4]. Providing highly active antiretroviral therapy to a woman will reduce viral replication and viral load during pregnancy, and as a postexposure prophylaxis, prevent infection in newborns [3, 5, 6]. Interventions to


[1]  “United Nations AIDS Program (UNAIDS),” 2010,
[2]  World Health Organization, Antiretroviral Drugs for Treating Pregnant Women and Preventing Infection in Infants: Towards Universal Access: Recommendations for a Public Health Approach, WHO, Geneva, Switzerland, 2006.
[3]  World Health Organization, “Prevention of Mother to Child Transmission (PMTCT). Briefing note. Department of HIV/AIDS,” 2007,
[4]  World Health Organization, “New guidance on prevention of mother-to-child transmission of HIV and infant feeding in the context of HIV,” 2010,
[5]  N. Siegfried, L. van der Merwe, P. Brocklehurst, and T. T. Sint, “Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection,” Cochrane Database of Systematic Reviews, no. 7, p. CD003510, 2011.
[6]  F. Dabis, M. L. Newell, L. Fransen et al., “Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice,” Health Policy and Planning, vol. 15, no. 1, pp. 34–42, 2000.
[7]  World Health Organization, “Towards Universal Access Progress Report,” 2010,
[8]  P. M. Barker, W. Mphatswe, and N. Rollins, “Antiretroviral drugs in the cupboard are not enough: the impact of health systems' performance on mother-to-child transmission of HIV,” Journal of Acquired Immune Deficiency Syndromes, vol. 56, no. 2, pp. e45–e48, 2011.
[9]  Z. P. Theilgaard, T. L. Katzenstein, M. G. Chiduo et al., “Addressing the fear and consequences of stigmatization—a necessary step towards making HAART accessible to women in Tanzania: a qualitative study,” AIDS Research and Therapy, vol. 8, no. 1, p. 28, 2011.
[10]  J. R. Chinkonde, J. Sundby, and F. Martinson, “The prevention of mother-to-child HIV transmission programme in Lilongwe, Malawi: why do so many women drop out,” Reproductive Health Matters, vol. 17, no. 33, pp. 143–151, 2009.
[11]  M. Manzi, R. Zachariah, R. Teck et al., “High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting,” Tropical Medicine and International Health, vol. 10, no. 12, pp. 1242–1250, 2005.
[12]  World Health Organization, The World Health Report, Geneva, Switzerland, 2005.
[13]  T. M. Painter, K. L. Diaby, D. M. Matia et al., “Women's reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study,” British Medical Journal, vol. 329, no. 7465, pp. 543–546, 2004.
[14]  “Ministry of Health Ethiopia & Federal HIV/AIDS Prevention and Control Office: Single Point HIV prevalence estimate,” Addis Ababa, Ethiopia, 2007.
[15]  “United Nations AIDS Program (UNAIDS)Epidemiological Fact Sheet on HIV and AIDS: Core Data on Epidemiology and Response. Ethiopia,” 2008,
[16]  “Federal HIV/AIDS Prevention and Control Office,” In Multi-sectoral HIV/AIDS Response Annual Monitoring and Evaluation Report 202 EFY, 2011.
[17]  T. Nigatu and Y. Woldegebriel, “Analysis of the prevention of mother-to-child transmission (PMTCT) service utilization in Ethiopia: 2006–2010,” Reproductive Health, vol. 8, no. 1, article 6, 2011.
[18]  T. Creek, R. Ntumy, L. Mazhani et al., “Factors associated with low early uptake of a national program to prevent mother to child transmission of HIV (PMTCT): results of a survey of mothers and providers, Botswana, 2003,” AIDS and Behavior, vol. 13, no. 2, pp. 356–364, 2009.
[19]  Z. Moges and A. Amberbir, “Factors associated with readiness to VCT service utilization among pregnant women attending antenatal clinics in Northwestern Ethiopia: a health belief model approach,” Ethiopian Journal of Health Sciences, vol. 21, supplement 1, pp. 107–115, 2011.
[20]  A. H. Mirkuzie, S. G. Hinderaker, and O. M?rkve, “Promising outcomes of a national programme for the prevention of mother-to-child HIV transmission in Addis Ababa: a retrospective study,” BMC Health Services Research, vol. 10, article 267, 2010.
[21]  O. Bolu, A. Anand, A. Swartzendruber et al., “Utility of antenatal HIV surveillance data to evaluate prevention of mother-to-child HIV transmission programs in resource-limited settings,” American Journal of Obstetrics and Gynecology, vol. 197, no. 3, supplement, pp. S17–S25, 2007.
[22]  G. Worku and F. Enquselassie, “Factors determining acceptance of voluntary HIV counseling and testing among pregnant women attending antenatal clinic at army hospitals in Addis Ababa,” Ethiopian Medical Journal, vol. 45, no. 1, pp. 1–8, 2007.
[23]  D. Jerene, A. Endale, and B. Lindtj?rn, “Acceptability of HIV counselling and testing among tuberculosis patients in south Ethiopia,” BMC International Health and Human Rights, vol. 7, article 4, 2007.
[24]  P. S. Maykut and S. Moorehouse, Beginning Qualitative Research: A Philosophic and Practical Guide, Falmer Press, London, UK, 1994.
[25]  C. Pope and N. Mays, Qualitative Research in Health Care, Blackwell, 3rd edition, 2006.
[26]  J. Green and N. Thorogood, Qualitative Methods for Health Research, Introducing Qualitative Methods, Sage, London, UK, 2004.
[27]  D. Gray, Doing Research in the Real World, Sage, London, UK, 2009.
[28]  E. F. Falnes, K. M. Moland, T. Tylleskar, M. M. de Paoli, S. C. Leshabari, and I. M. S. Engebretsen, “The potential role of mother-in-law in prevention of mother-to-child transmission of HIV: a mixed methods study from the Kilimanjaro region, Northern Tanzania,” BMC Public Health, vol. 11, article 551, 2011.
[29]  R. Byamugisha, J. K. Tumwine, N. Semiyaga, and T. Tyllesk?r, “Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey,” Reproductive Health, vol. 7, no. 1, article 12, 2010.
[30]  E. C. Larsson, A. Thorson, G. Pariyo et al., “Opt-out HIV testing during antenatal care: experiences of pregnant women in rural Uganda,” Health Policy and Planning, vol. 27, no. 1, pp. 69–75, 2011.
[31]  L. R. ?stergaard and A. Bula, ““They call our children “Nevirapine babies?””: a qualitative study about exclusive breastfeeding among HIV positive mothers in Malawi,” African Journal of Reproductive Health, vol. 14, no. 3, pp. 213–222, 2010.
[32]  M. Conkling, E. L. Shutes, E. Karita et al., “Couples' voluntary counselling and testing and nevirapine use in antenatal clinics in two African capitals: a prospective cohort study,” Journal of the International AIDS Society, vol. 13, p. 10, 2010.
[33]  K. Peltzer, T. Mosala, O. Shisana, A. Nqueko, and N. Mngqundaniso, “Barriers to prevention of HIV transmission from mother to child (PMTCT) in a resource poor setting in the Eastern Cape, South Africa,” African Journal of Reproductive Health, vol. 11, no. 1, pp. 57–66, 2007.
[34]  B. Nattabi, J. Li, S. C. Thompson, C. G. Orach, and J. Earnest, “Factors associated with perceived stigma among peopleliving with hiv/aids in post-conflict northern Uganda,” AIDS Education and Prevention, vol. 23, no. 3, pp. 193–205, 2011.
[35]  R. Cianelli, L. Ferrer, K. F. Norr et al., “Stigma related to HIV among community health workers in Chile,” Stigma Research and Action, vol. 1, no. 1, pp. 3–10, 2011.
[36]  T. Whitaker, P. Ryan, and G. Cox, “Stigmatization among drug-using sex workers accessing support services in Dublin,” Qualitative Health Research, vol. 21, no. 8, pp. 1086–1100, 2011.
[37]  H. Muyinda, J. Seeley, H. Pickering, and T. Barton, “Social aspects of AIDS-related stigma in rural Uganda,” Health and Place, vol. 3, no. 3, pp. 143–147, 1997.
[38]  S. Walmsley, “Opt in or opt out: what is optimal for prenatal screening for HIV infection?” Canadian Medical Association Journal, vol. 168, no. 6, pp. 707–708, 2003.
[39]  C. Sprague, M. F. Chersich, and V. Black, “Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry,” AIDS Research and Therapy, vol. 8, no. 10, pp. 10–18, 2011.
[40]  Federal Ministry of Health: Report on Situational Analysis of the National PMTCT of HIV/AIDS Program Response in the Broader RH/MCH Context in Ethiopia, Addis- Ababa, 2009.
[41]  H. Banteyerga, “Ethiopia's Health Extension Program: improving health through community involvement,” MEDICC Review, vol. 13, no. 3, pp. 46–49, 2011.
[42]  K. Hermann, W. Van Damme, G. W. Pariyo et al., “Community health workers for ART in sub-Saharan Africa: learning from experience—capitalizing on new opportunities,” Human Resources for Health, vol. 7, article 31, 2009.
[43]  W. Wakabi, “Extension workers drive Ethiopia's primary health care,” The Lancet, vol. 372, no. 9642, p. 880, 2008.


comments powered by Disqus