Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment
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HIV-positive pregnant women who are initiated on lifelong antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) have lower adherence rates after delivery. We quantified maternal motivation to take preventive therapy before and after delivery among pregnant women newly diagnosed with HIV. We enrolled pregnant women (≥ 18 years) with a recent HIV diagnosis (< 6 months) at 14 public primary health clinics in Matlosana, South Africa and followed them in the postpartum period. Participants received eight choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapy identified through literature reviews and key informant interviews. Data was analyzed using conditional logit regression in the antepartum versus postpartum periods. Coefficients are reported with 95% confidence intervals (CI). Sixty-five women completed surveys both at enrollment and in the postpartum period. All women were already on ART, while 21 (32%) were receiving IPT at enrollment. The mean CD4 count was 436 (± 246) cells/mm3. In the antepartum period, preventing HIV transmission to partners was the most important benefit (coefficients (ß) = 0.87, 95% CI 0.64, 1.11), followed by keeping healthy for family (ß = 0.75, 95% CI 0.52, 0.97). Such prioritization significantly decreased in the postpartum period (p < 0.001). Compared to other motivators, keeping a high CD4 count was least prioritized in the antepartum period (ß = 0.19, 95% CI − 0.04, 0.43) but was most prioritized in the postpartum period (ß = 0.39, 95% CI 0.21, 0.57). These results highlight that messages on family might be particularly salient in the antepartum period, and keeping CD4 count high in the postpartum period. Understanding maternal motivation may help to design targeted health promotion messages to HIV-positive women around the time of delivery.
KeywordsDiscrete choice experiment Isoniazid preventive therapy Antiretroviral therapy Pregnant women South Africa
We thank all study participants for devoting their time to take part in this study. We thank our study coordinators, Sandy Chon, Cokiswa Quomfo, Juanita Market, Mmabatho Malegotsia, Elvis Rangxa, Thembekile Mmmoledi as well as all study staff who helped in data collection.
All authors contributed to design the study. H-YK, CFH, and NM helped to collect the data. H-YK and JFPB performed the data analysis. DK and CT conducted the qualitative interviews. HYK wrote the initial draft of the paper. All authors contributed to read and revised the final manuscript.
This study was funded by NIH supplement R01AI095014 02S1.
Compliance with Ethical Standards
Conflict of interest
The authors declared that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.UNAIDS. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Geneva; 2011.Google Scholar
- 4.Pillay T, Khan M, Moodley J. The increasing burden of tuberculosis in pregnant women, newborns and infants under 6 months of age in Durban, KwaZulu-Natal. South African. Med J. 2001;91(11):983–7.Google Scholar
- 6.Department of Health Republic of South Africa. National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults. 2015.Google Scholar
- 7.World Health Organization. Global Tuberculosis Report 2017. Geneva; 2017.Google Scholar
- 11.Rowe KA, Makhubele B, Hargreaves JR, Porter JD, Hausler HP, Pronyk PM. Adherence to TB preventive therapy for HIV-positive patients in rural South Africa: implications for antiretroviral delivery in resource-poor settings? Int J Tuberc Lung Dis. 2005;9(3):263–9.Google Scholar
- 14.Tiam A, Machekano R, Gounder CR, Maama-maime LBM, Ntene-sealiete K, Sahu M, et al. Preventing tuberculosis among HIV-infected pregnant women in Lesotho: the case for rolling out active case finding and isoniazid preventive therapy. J Acquir Immune Defic Syndr. 2014;67(1):e5–11.CrossRefGoogle Scholar
- 15.Reda AA, Biadgilign S. Determinants of adherence to antiretroviral therapy among HIV-infected patients in Africa. AIDS Res Treat. 2012;2012:574656.Google Scholar
- 16.Carrieri MP, Leport C, Protopopescu C, Cassuto JP, Bouvet E, Peyramond D, et al. Factors associated with nonadherence to highly active antiretroviral therapy: a 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. J Acquir Immune Defic Syndr. 2006;41(4):477–85.CrossRefGoogle Scholar
- 20.Golub J, Lebina L, Qomfu C, Chon S, Cohn S, Masonoke K, et al. Implementation of QuantiFERON®– TB Gold In-Tube test for diagnosing latent tuberculosis among newly diagnosed HIV-infected patients in South Africa. In: In: 46th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union). Cape Town, South Africa; 2015. p. [Abstract OA-399-05].Google Scholar
- 21.Kerrigan D, Tudor C, Motlhaoleng K, Lebina L, Qomfu C, Variava E, et al. Relevance and acceptability of using the Quantiferon gold test (QGIT) to screen CD4 blood draws for latent TB infection among PLHIV in South Africa: formative qualitative research findings from the TEKO trial. BMC Health Serv Res. 2018;18(1):288.CrossRefGoogle Scholar
- 23.Newman PA, Cameron MP, Roungprakhon S, Tepjan S, Scarpa R. Acceptability and preferences for hypothetical rectal microbicides among a community sample of young men who have sex with men and transgender women in Thailand: a discrete choice experiment. AIDS Behav. 2016;20(11):2588–601.CrossRefGoogle Scholar
- 27.Sutton R, Lahuerta M, Abacassamo F, Ahoua L, Tomo M, Lamb MR, et al. Feasibility and acceptability of health communication interventions within a combination intervention strategy for improving linkage and retention in HIV care in Mozambique. J Acquir Immune Defic Syndr. 2017;74(Suppl 1):S29–36.CrossRefGoogle Scholar
- 30.Montgomery DC. Design and analysis of experiments. Hoboken: Wiley; 2017.Google Scholar
- 31.Orme B. Getting started with conjoint analysis: strategies for product design and pricing research. Madison: Research Publishers LLC; 2006.Google Scholar
- 37.Lake Snell Perry & Associates Inc. The healthcare experiences of women with HIV/AIDS: Insights from focus groups. Henry Kaiser Family Foundation. 2003.Google Scholar
- 41.Department of Health Republic of South Africa. One Year of Operation: A Case Study Mom Connect. 2015.Google Scholar