Advertisement

Maternal and Child Health Journal

, Volume 23, Issue 1, pp 30–38 | Cite as

Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis

  • Catherine E. FordEmail author
  • David Coetzee
  • Jennifer Winston
  • Carla J. Chibwesha
  • Didier K. Ekouevi
  • Thomas K. Welty
  • Pius M. Tih
  • Suzanne Maman
  • Elizabeth M. Stringer
  • Jeffrey S. A. Stringer
  • Benjamin H. Chi
Article
  • 67 Downloads

Abstract

Objectives We investigated whether a woman’s role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d’Ivoire, South Africa, and Zambia. Our exposure of interest was the women’s role (active vs. not active) in decision-making about her healthcare, large household purchases, children’s schooling, and children’s healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00–2.89 all p < .05). However, associations between decision-making and antiretroviral use—for both mother and infant—were generally not significant. An exception was active decision-making in a woman’s own healthcare and reported maternal antiretroviral use (AOR 1.69, p < 0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services.

Keywords

Women Prevention Children PMTCT cascade Decision-making Infant HIV testing 

Notes

Acknowledgements

The Zambia, South Africa, and Cote d’Ivoire work was supported by contract T0906150021 from the US Centers for Disease Control and Prevention Global AIDS Program. The Cameroon work was supported by a Grant from The Bill & Melinda Gates Foundation (351-07), which was awarded through the Elizabeth Glaser Pediatric AIDS Foundation. Additional trainee and administrative support was provided by the U.S. National Institutes of Health (T32 HD075731, R25 TW009340, K24 AI120796, P30 AI050410). None of the funding agencies were involved in the design, conduct, or interpretation of this analysis, nor did they participate in the preparation, review, and approval of the manuscript.

References

  1. Ambia, J., & Mandala, J. (2016). A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention. Journal of the International AIDS Society, 19(1), 20309.  https://doi.org/10.7448/IAS.19.1.20309.CrossRefGoogle Scholar
  2. Barker, P. M., Mphatswe, W., & Rollins, N. (2011). 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, 56(2), e45–e48.  https://doi.org/10.1097/QAI.0b013e3181fdbf20.CrossRefGoogle Scholar
  3. Bashemera, D. R., Nhembo, M. J., & Benedict, G. (2013). The role of women’s empowerment in influencing HIV testing. DHS Working Papers No. 101. Accessed January 12, 2018, from https://dhsprogram.com/pubs/pdf/WP101/WP101.pdf.
  4. Buregyeya, E., Naigino, R., Mukose, A., Makumbi, F., Esiru, G., Arinaitwe, J., … Wanyenze, R. K. (2017). Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: A qualitative study. BMC Pregnancy Childbirth, 17(1), 94.  https://doi.org/10.1186/s12884-017-1276-x.CrossRefGoogle Scholar
  5. Central Statistical Office [Zambia], Central Board of Health [Zambia], & ORC Macro. (2015). Zambia demographic and health survey 2013–2014. Calverton, MA: Central Statistical Office, Central Board of Health, and ORC Macro.Google Scholar
  6. Chi, B. H., Tih, P. M., Zanolini, A., Stinson, K., Ekouevi, D. K., Coetzee, D., … Stringer, J. S. (2015). Reconstructing the PMTCT cascade using cross-sectional household survey data: The PEARL Study. Journal of Acquired Immune Deficiency Syndromes.  https://doi.org/10.1097/QAI.0000000000000718.Google Scholar
  7. Chimbwandria, F., Mhango, E., Makombe, S., Midiani, D., Njala, J., Chirwa, Z., … Houston, J. (2013). Impact of an innovative approach to prevent mother-to-child transmission of HIV: Malawi, July 2011-September 2012. Morbidity and Mortality Weekly Report, 62, 148–151.Google Scholar
  8. Corroon, M., Speizer, I. S., Fotso, J. C., Akiode, A., Saad, A., Calhoun, L., & Irani, L. (2014). The role of gender empowerment on reproductive health outcomes in urban Nigeria. Maternal and Child Health Journal, 18(1), 307–315.  https://doi.org/10.1007/s10995-013-1266-1.CrossRefGoogle Scholar
  9. Ekouevi, D. K., Stringer, E., Coetzee, D., Tih, P., Creek, T., Stinson, K., … Dabis, F. (2012). Health facility characteristics and their relationship to coverage of PMTCT of HIV services across four African countries: The PEARL study. PLoS ONE, 7(1), e29823.  https://doi.org/10.1371/journal.pone.0029823.CrossRefGoogle Scholar
  10. Finocchario-Kessler, S., Clark, K. F., Khamadi, S., Gautney, B. J., Okoth, V., Goggin, K., & Team, H. I. S. (2016). Progress toward eliminating mother to child transmission of HIV in Kenya: Review of treatment guideline uptake and pediatric transmission at four government hospitals between 2010 and 2012. AIDS and Behavior, 20(11), 2602–2611.  https://doi.org/10.1007/s10461-015-1071-5.CrossRefGoogle Scholar
  11. Flax, V. L., Yourkavitch, J., Okello, E. S., Kadzandira, J., Katahoire, A. R., & Munthali, A. C. (2017). “If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B + prevention of mother-to-child transmission participation in Malawi and Uganda. PLoS ONE, 12(6), e0178298.  https://doi.org/10.1371/journal.pone.0178298.CrossRefGoogle Scholar
  12. Ford, C., Chibwesha, C. J., Winston, J., Jacobs, C., Lubeya, M. K., Musonda, P., … Chi, B. H. (2017). Women’s decision-making and uptake of services to prevent mother-to-child HIV transmission in Zambia. AIDS Care.  https://doi.org/10.1080/09540121.2017.1381328.Google Scholar
  13. Fowler, M. G., Qin, M., Fiscus, S. A., Currier, J. S., Flynn, P. M., Chipato, T., … Team, I. B. F. P. S. (2016). Benefits and risks of antiretroviral therapy for perinatal HIV prevention. The New England Journal of Medicine, 375(18), 1726–1737.  https://doi.org/10.1056/NEJMoa1511691.CrossRefGoogle Scholar
  14. Granato, S. A., Gloyd, S., Robinson, J., Dali, S. A., Ahoba, I., Aka, D., … Kone, A. (2016). Results from a rapid national assessment of services for the prevention of mother-to-child transmission of HIV in Cote d’Ivoire. Journal of the International AIDS Society, 19(5 Suppl 4), 20838.  https://doi.org/10.7448/IAS.19.5.20838.Google Scholar
  15. Groves, A. K., Maman, S., Msomi, S., Makhanya, N., & Moodley, D. (2010). The complexity of consent: Women’s experiences testing for HIV at an antenatal clinic in Durban, South Africa. AIDS Care, 22(5), 538–544.  https://doi.org/10.1080/09540120903311508.CrossRefGoogle Scholar
  16. Haas, A. D., Msukwa, M. T., Egger, M., Tenthani, L., Tweya, H., Jahn, A., … Keiser, O. (2016a). Adherence to antiretroviral therapy during and after pregnancy: Cohort study on women receiving care in Malawi’s option B + program. Clinical Infectious Diseases, 63(9), 1227–1235.  https://doi.org/10.1093/cid/ciw500.Google Scholar
  17. Haas, A. D., Tenthani, L., Msukwa, M. T., Tal, K., Jahn, A., Gadabu, O. J., … Keiser, O. (2016b). Retention in care during the first 3 years of antiretroviral therapy for women in Malawi’s option B + programme: An observational cohort study. Lancet HIV, 3(4), e175–e182.  https://doi.org/10.1016/S2352-3018(16)00008-4.CrossRefGoogle Scholar
  18. Joint United Nations Programme on HIV/AIDS. (2016). On the fast-track to an AIDS-free generation. Accessed January 12, 2018, from http://www.unaids.org/sites/default/files/media_asset/GlobalPlan2016_en.pdf.
  19. Kesho Bora Study Group. (2011). Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): A randomised controlled trial. The Lancet Infectious Diseases, 11(3), 171–180.  https://doi.org/10.1016/S1473-3099(10)70288-7.CrossRefGoogle Scholar
  20. Kishor, S., & Subaiya, L. (2008). Understanding women’s empowerment: A comparative analysis of Demographic and Health Surveys (DHS) data. DHS Comparative Reports No. 20, October 2008. Accessed January 12, 2018, from http://dhsprogram.com/pubs/pdf/CR20/CR20.pdf.
  21. McNairy, M. L., Teasdale, C. A., El-Sadr, W. M., Mave, V., & Abrams, E. J. (2015). Mother and child both matter: Reconceptualizing the prevention of mother-to-child transmission care continuum. Current Opinion in HIV and AIDS.  https://doi.org/10.1097/COH.0000000000000199.Google Scholar
  22. Mitiku, I., Addissie, A., & Molla, M. (2017). Perceptions and experiences of pregnant women about routine HIV testing and counselling in Ghimbi town, Ethiopia: A qualitative study. BMC Research Notes, 10(1), 101.  https://doi.org/10.1186/s13104-017-2423-1.CrossRefGoogle Scholar
  23. Musheke, M., Ntalasha, H., Gari, S., McKenzie, O., Bond, V., Martin-Hilber, A., & Merten, S. (2013). A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health, 13, 220.  https://doi.org/10.1186/1471-2458-13-220.CrossRefGoogle Scholar
  24. Mutowo, J., Kasu, C. M., & Mufunda, E. (2014). Women empowerment and practices regarding use of dual protection among family planning clients in urban Zimbabwe. Pan African Medical Journal, 17, 300.  https://doi.org/10.11604/pamj.2014.17.300.3282.CrossRefGoogle Scholar
  25. Naburi, H., Mujinja, P., Kilewo, C., Barnighausen, T., Orsini, N., Manji, K., … Ekstrom, A. M. (2016). Predictors of patient dissatisfaction with services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania. PLoS ONE, 11(10), e0165121.  https://doi.org/10.1371/journal.pone.0165121.CrossRefGoogle Scholar
  26. Ngarina, M., Popenoe, R., Kilewo, C., Biberfeld, G., & Ekstrom, A. M. (2013). Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health: Experiences from the Mitra Plus study in Tanzania. BMC Public Health, 13, 450.  https://doi.org/10.1186/1471-2458-13-450.CrossRefGoogle Scholar
  27. Shapiro, R. L., Hughes, M. D., Ogwu, A., Kitch, D., Lockman, S., Moffat, C., … Essex, M. (2010). Antiretroviral regimens in pregnancy and breast-feeding in Botswana. The New England Journal of Medicine, 362(24), 2282–2294.  https://doi.org/10.1056/NEJMoa0907736.CrossRefGoogle Scholar
  28. Stringer, E. M., Chi, B. H., Chintu, N., Creek, T. L., Ekouevi, D. K., Coetzee, D., … Stringer, J. S. (2008). Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Bulletin of the World Health Organization, 86(1), 57–62.CrossRefGoogle Scholar
  29. Stringer, E. M., Ekouevi, D. K., Coetzee, D., Tih, P. M., Creek, T. L., Stinson, K., … Stringer, J. S. (2010). Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries. JAMA, 304(3), 293–302.  https://doi.org/10.1001/jama.2010.990304/3/293.CrossRefGoogle Scholar
  30. Stringer, J. S., Stinson, K., Tih, P. M., Giganti, M. J., Ekouevi, D. K., Creek, T. L., … Coetzee, D. (2013). Measuring coverage in MNCH: Population HIV-free survival among children under two years of age in four African countries. PLoS Medicine, 10(5), e1001424.  https://doi.org/10.1371/journal.pmed.1001424.CrossRefGoogle Scholar
  31. Violari, A., Cotton, M. F., Gibb, D. M., Babiker, A. G., Steyn, J., Madhi, S. A., … McIntyre, J. A. (2008). Early antiretroviral therapy and mortality among HIV-infected infants. The New England Journal of Medicine, 359(21), 2233–2244.  https://doi.org/10.1056/NEJMoa0800971.CrossRefGoogle Scholar
  32. Wettstein, C., Mugglin, C., Egger, M., Blaser, N., Vizcaya, L. S., & Estill, J.… Keiser, O. (2012). Missed opportunities to prevent mother-to-child-transmission: Systematic review and meta-analysis. AIDS, 26(18), 2361–2373.  https://doi.org/10.1097/QAD.0b013e328359ab0c.CrossRefGoogle Scholar
  33. Woldesenbet, S., Jackson, D., Lombard, C., Dinh, T. H., Puren, A., Sherman, G., … South African, P. E. T. (2015). Missed opportunities along the prevention of mother-to-child transmission services cascade in South Africa: Uptake, determinants, and attributable risk (the SAPMTCTE). PLoS ONE, 10(7), e0132425.  https://doi.org/10.1371/journal.pone.0132425.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Catherine E. Ford
    • 1
    • 6
    Email author
  • David Coetzee
    • 2
  • Jennifer Winston
    • 1
  • Carla J. Chibwesha
    • 1
  • Didier K. Ekouevi
    • 3
  • Thomas K. Welty
    • 4
  • Pius M. Tih
    • 4
  • Suzanne Maman
    • 5
  • Elizabeth M. Stringer
    • 1
  • Jeffrey S. A. Stringer
    • 1
  • Benjamin H. Chi
    • 1
    return OK on get
  1. 1.Department of Obstetrics and GynecologyUniversity of North Carolina School of MedicineChapel HillUSA
  2. 2.Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
  3. 3.University of Bordeaux, ISPED, Centre INSERM U897BordeauxFrance
  4. 4.Cameroon Baptist Health Convention Health BoardBamendaCameroon
  5. 5.Department of Health BehaviorUniversity of North Carolina Gillings School of Public HealthChapel HillUSA
  6. 6.Department of Obstetrics and GynecologyUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations