Skip to main content

Advertisement

SpringerLink
Log in

Acceptability of Interventions to Improve Engagement in HIV Care Among Pregnant and Postpartum Women at Two Urban Clinics in South Africa

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Introduction

Pregnant women initiating antiretroviral therapy (ART) in sub-Saharan Africa have been shown to have sub-optimal engagement in care, particularly after delivery, and interventions to improve engagement in care for this unique population are urgently needed.

Methods

We enrolled 25 pregnant women living with HIV at each of two large antenatal clinics in Johannesburg and Cape Town, South Africa (n = 50), and conducted in-depth interviews. We assessed participants’ reported acceptability of the following proposed interventions to improve engagement in care and retention monitoring data systems: financial incentives, educational toys, health education, combined maternal/infant visits, cell phone text reminders, mobility tracking, fingerprint/biometric devices, and smartcards.

Results

Acceptability overall for interventions was high, with mixed responses for some interventions. Overall themes identified included (i) the intersection of individual and facility responsibility for a patient’s health, (ii) a call for more health education, (iii) issues of disclosure and concerns about privacy, and (iv) openness to interventions that could improve health systems.

Discussion

These findings provide insight into the preferences and concerns of potential users of interventions to improve engagement in HIV care for pregnant women, and support the development of tools that specifically target this high-risk group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • An, S. J., George, A. S., LeFevre, A., Mpembeni, R., Mosha, I., Mohan, D., et al. (2015). Program synergies and social relations: Implications of integrating HIV testing and counselling into maternal health care on care seeking. BMC Public Health, 15(1), 24. https://doi.org/10.1186/s12889-014-1336-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52(1), 1–26.

    Article  CAS  Google Scholar 

  • Bärnighausen, T., Chaiyachati, K., Chimbindi, N., Peoples, A., Haberer, J., & Newell, M.-L. (2011). Interventions to increase antiretroviral adherence in sub-Saharan Africa: A systematic review of evaluation studies. The Lancet Infectious Diseases, 11(12), 942–951.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bogart, L. M., Chetty, S., Giddy, J., Sypek, A., Sticklor, L., Walensky, R. P., et al. (2012). Barriers to care among people living with HIV in South Africa: Contrasts between patient and healthcare provider perspectives. AIDS Care, 25(7), 843–853.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chaiyachati, K. (2014). Interventions to improve adherence to antiretroviral therapy: A rapid systematic review. AIDS, 28, S187–S204. https://doi.org/10.1097/QAD.0000000000000252ISSN.

    Article  PubMed  Google Scholar 

  • Chamie, G., Schaffer, E. M., Ndyabakira, A., Emperador, D. M., Kwarisiima, D., Camlin, C. S., et al. (2018). Comparative effectiveness of novel nonmonetary incentives to promote HIV testing. AIDS, 32(11), 1443–1451.

    Article  PubMed  PubMed Central  Google Scholar 

  • Clouse, K., Mongwenyana, C., Musina, M., Bokaba, D., Long, L., Maskew, M., et al. (2018). Acceptability and feasibility of a financial incentive intervention to improve retention in HIV care among pregnant women in Johannesburg, South Africa. AIDS Care, 30(4), 453–460.

    Article  PubMed  Google Scholar 

  • Clouse, K., Pettifor, A., Shearer, K., Maskew, M., Bassett, J., Larson, B., et al. (2013). Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa. Tropical Medicine and International Health, 18(4), 451–460.

    Article  PubMed  Google Scholar 

  • Clouse, K., Schwartz, S., Van Rie, A., Bassett, J., Yende, N., & Pettifor, A. (2014). What they wanted was to give birth; nothing else: Barriers to retention in option B + HIV care among postpartum women in South Africa. Journal of Acquired Immune Deficiency Syndromes, 67(1), e12–e18.

    Article  PubMed  Google Scholar 

  • Clouse, K., Vermund, S. H., Maskew, M., Lurie, M. N., MacLeod, W., Malete, G., et al. (2017). Mobility and clinic switching among postpartum women considered lost to HIV care in South Africa. Journal of Acquired Immune Deficiency Syndromes, 74(4), 383–389.

    Article  PubMed  Google Scholar 

  • Colvin, C. J., Konopka, S., Chalker, J. C., Jonas, E., Albertini, J., Amzel, A., et al. (2014). A systematic review of health system barriers and enablers for antiretroviral therapy (ART) for HIV-infected pregnant and postpartum women. PLoS ONE, 9(10), e108150.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dapaah, J. M., & Senah, K. A. (2016). HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana. BMC Medical Ethics, 17(1), 41.

    Article  PubMed  PubMed Central  Google Scholar 

  • El-Sadr, W. M., Donnell, D., Beauchamp, G., Hall, H. I., Torian, L. V., Zingman, B., et al. (2017). Financial incentives for linkage to care and viral suppression among HIV-positive patients. JAMA Internal Medicine, 177(8), 1083–1092.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fox, M. P., Bor, J., Brennan, A. T., MacLeod, W. B., Maskew, M., Stevens, W. S., et al. (2018). Estimating retention in HIV care accounting for patient transfers: A national laboratory cohort study in South Africa. PLoS Medicine, 15(6), e1002589.

    Article  PubMed  PubMed Central  Google Scholar 

  • Geldsetzer, P., Yapa, H. M. N., Vaikath, M., Ogbuoji, O., Fox, M. P., Essajee, S. M., et al. (2016). A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care. Journal of the International AIDS Society, 19(1), 20679.

    Article  PubMed  PubMed Central  Google Scholar 

  • Geng, E. H., Glidden, D. V., Emenyonu, N., Musinguzi, N., Bwana, M. B., Neilands, T. B., et al. (2010). Tracking a sample of patients lost to follow-up has a major impact on understanding determinants of survival in HIV-infected patients on antiretroviral therapy in Africa. Tropical Medicine and International Health, 15(Suppl 1), 63–69.

    Article  PubMed  Google Scholar 

  • Gourlay, A., Birdthistle, I., Mburu, G., Iorpenda, K., & Wringe, A. (2013). Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: A systematic review. Journal of the International AIDS Society, 16(1), 18588.

    Article  PubMed  PubMed Central  Google Scholar 

  • Govindasamy, D., Ford, N., & Kranzer, K. (2012). Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: A systematic review. AIDS, 26(16), 2059–2067.

    Article  CAS  PubMed  Google Scholar 

  • Greene, E., Pack, A., Stanton, J., Shelus, V., Tolley, E. E., Taylor, J., et al. (2017). It makes you feel like someone cares; acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study. PLoS ONE, 12(2), e0170686.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Haas, A. D., Tenthani, L., Msukwa, M. T., Tal, K., Jahn, A., Gadabu, O. J., et al. (2016). Retention in care during the first 3 years of antiretroviral therapy for women in Malawi’s option B+ programme: An observational cohort study. The Lancet HIV, 3(4), e175–e182.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hodgson, I., Plummer, M. L., Konopka, S. N., Colvin, C. J., Jonas, E., Albertini, J., et al. (2014). A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS ONE, 9(11), e111421.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Joint United Nations Programme on HIV/AIDS (UNAIDS). (2016a). On the Fast-track to an AIDS-free Generation. Geneva.

  • Joint United Nations Programme on HIV/AIDS (UNAIDS). (2016b). Prevention Gap Report. Geneva.

  • Kemp, C. G., Weiner, B. J., Sherr, K. H., Kupfer, L. E., Cherutich, P. K., Wilson, D., et al. (2018). Implementation science for integration of HIV and non-communicable disease services in sub-Saharan Africa. AIDS, 32, S93–S105.

    Article  PubMed  Google Scholar 

  • Knettel, B. A., Cichowitz, C., Ngocho, J. S., Knippler, E. T., Chumba, L. N., Mmbaga, B. T., et al. (2018). Retention in HIV care during pregnancy and the postpartum period in the option B+ era. Journal of Acquired Immune Deficiency Syndromes, 77(5), 427–438. https://doi.org/10.1097/QAI.0000000000001616.

    Article  PubMed  Google Scholar 

  • Kohler, P. K., Ondenge, K., Mills, L. A., Okanda, J., Kinuthia, J., Olilo, G., et al. (2014). Shame, guilt, and stress: Community perceptions of barriers to engaging in prevention of mother to child transmission (PMTCT) programs in western Kenya. AIDS Patient Care and STDs, 28(12), 643–651.

    Article  PubMed  PubMed Central  Google Scholar 

  • Linnemayr, S., Stecher, C., & Mukasa, B. (2017). Behavioral economic incentives to improve adherence to antiretroviral medication. AIDS, 31(5), 719–726.

    Article  PubMed  PubMed Central  Google Scholar 

  • MacPhail, C., Adato, M., Kahn, K., Selin, A., Twine, R., Khoza, S., et al. (2013). Acceptability and feasibility of cash transfers for HIV prevention among adolescent South African women. AIDS and Behavior, 17(7), 2301–2312.

    Article  PubMed  PubMed Central  Google Scholar 

  • Maughan-Brown, B., Smith, P., Kuo, C., Harrison, A., Lurie, M. N., Bekker, L.-G., et al. (2018). A conditional economic incentive fails to improve linkage to care and antiretroviral therapy initiation among HIV-positive adults in Cape Town, South Africa. AIDS Patient Care and STDs, 32(2), 70–78.

    Article  PubMed  PubMed Central  Google Scholar 

  • Merten, S., Kenter, E., McKenzie, O., Musheke, M., Ntalasha, H., & Martin-Hilber, A. (2010). Patient-reported barriers and drivers of adherence to antiretrovirals in sub-Saharan Africa: A meta-ethnography. Tropical Medicine and International Health, 15(Suppl 1), 16–33.

    Article  PubMed  Google Scholar 

  • Mills, E. J., Nachega, J. B., Bangsberg, D. R., Singh, S., Rachlis, B., Wu, P., et al. (2006). Adherence to HAART: A systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Medicine, 3(11), e438.

    Article  PubMed  PubMed Central  Google Scholar 

  • Musoke, P., Gakumo, C. A., Abuogi, L. L., Akama, E., Bukusi, E., Helova, A., et al. (2018). A text messaging intervention to support option B+ in kenya: A qualitative study. Journal of the Association of Nurses in AIDS Care, 29(2), 287–299.

    Article  PubMed  Google Scholar 

  • Myer, L., & Phillips, T. K. (2017). Beyond “Option B+”. Journal of Acquired Immune Deficiency Syndromes, 75, S115–S122.

    Article  PubMed  Google Scholar 

  • Myer, L., Phillips, T. K., Zerbe, A., Ronan, A., Hsiao, N.-Y., Mellins, C. A., et al. (2016). Optimizing antiretroviral therapy (art) for maternal and child health (MCH). JAIDS Journal of Acquired Immune Deficiency Syndromes, 72(Suppl 2), S189–S196.

    Article  PubMed  Google Scholar 

  • Nachega, J., Skinner, D., Jennings, L., Magidson, J., Altice, F., Burke, J., et al. (2016). Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+ : An exploratory study. Patient Preference and Adherence, 10, 683.

    Article  PubMed  PubMed Central  Google Scholar 

  • Phillips, T. K., Clouse, K., Zerbe, A., Orrell, C., Abrams, E. J., & Myer, L. (2018). Linkage to care, mobility and retention of HIV-positive postpartum women in antiretroviral therapy services in South Africa. Journal of the International AIDS Society, 21 e25114.

    Article  PubMed  PubMed Central  Google Scholar 

  • Phillips, T. K., McNairy, M. L., Zerbe, A., Myer, L., & Abrams, E. J. (2015). Implementation and operational research: postpartum transfer of care among HIV-infected women initiating antiretroviral therapy during pregnancy. Journal of Acquired Immune Deficiency Syndromes, 70(3), e102–e109.

    Article  CAS  PubMed  Google Scholar 

  • Phillips, T. K., Thebus, E., Bekker, L.-G., Mcintyre, J., Abrams, E. J., & Myer, L. (2014). Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: A cohort study. Journal of the International AIDS Society, 17, 19242.

    Article  PubMed  PubMed Central  Google Scholar 

  • Posse, M., Meheus, F., van Asten, H., van der Ven, A., & Baltussen, R. (2008). Barriers to access to antiretroviral treatment in developing countries: A review. Tropical Medicine and International Health, 13(7), 904–913.

    Article  PubMed  Google Scholar 

  • Ronen, K., Unger, J. A., Drake, A. L., Perrier, T., Akinyi, P., Osborn, L., et al. (2018). SMS messaging to improve ART adherence: perspectives of pregnant HIV-infected women in Kenya on HIV-related message content. AIDS Care, 30(4), 500–505.

    Article  PubMed  Google Scholar 

  • Schwartz, S. R., Clouse, K., Yende, N., Van Rie, A., Bassett, J., Ratshefola, M., et al. (2015). Acceptability and feasibility of a mobile phone-based case management intervention to retain mothers and infants from an option B+ program in postpartum HIV care. Maternal and Child Health Journal, 19(9), 2029–2037.

    Article  PubMed  PubMed Central  Google Scholar 

  • Serwaa-Bonsu, A., Herbst, A. J., Reniers, G., Ijaa, W., Clark, B., Kabudula, C., et al. (2010). First experiences in the implementation of biometric technology to link data from Health and Demographic Surveillance Systems with health facility data. Global Health Action, 3(1), 2120.

    Article  Google Scholar 

  • Shubber, Z., Mills, E. J., Nachega, J. B., Vreeman, R., Freitas, M., Bock, P., et al. (2016). Patient-reported barriers to adherence to antiretroviral therapy: A systematic review and meta-analysis. PLoS Medicine, 13(11), e1002183.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sibanda, E. L., Tumushime, M., Mufuka, J., Mavedzenge, S. N., Gudukeya, S., Bautista-Arredondo, S., et al. (2017). Effect of non-monetary incentives on uptake of couples’ counselling and testing among clients attending mobile HIV services in rural Zimbabwe: A cluster-randomised trial. The Lancet Global Health, 5(9), e907–e915.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sikombe, K., Kadota, J. L., Simbeza, S., Eshun-Wilson, I., Beres, L., Moore, C. B., Geng, E. H. (2018). Understanding patient mobility in HIV-positive adults across multiple clinics in Zambia. In Conference on Retroviruses and Opportunistic Infections. Boston, MA.

  • Sindelar, J. L. (2008). Paying for performance: the power of incentives over habits. Health Economics, 17(4), 449–451.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stern, E., Colvin, C., Gxabagxaba, N., Schutz, C., Burton, R., & Meintjes, G. (2017). Conceptions of agency and constraint for HIV-positive patients and healthcare workers to support long-term engagement with antiretroviral therapy care in Khayelitsha, South Africa. African Journal of AIDS Research, 16(1), 19–29.

    Article  PubMed  Google Scholar 

  • Tolley, E. E., Taylor, J., Pack, A., Greene, E., Stanton, J., Shelus, V., et al. (2018). The role of financial incentives along the antiretroviral therapy adherence continuum: A qualitative sub-study of the HPTN 065 (TLC-Plus) study. AIDS and Behavior, 22(1), 245–257.

    Article  PubMed  Google Scholar 

  • Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357.

    Article  PubMed  Google Scholar 

  • Venables, E., Edwards, J. K., Baert, S., Etienne, W., Khabala, K., & Bygrave, H. (2016). They just come, pick and go. The acceptability of integrated medication adherence clubs for HIV and non communicable disease (ncd) patients in Kibera, Kenya. PloS ONE, 11(10), e0164634.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wall, K. M., Kilembe, W., Inambao, M., Chen, Y. N., Mchoongo, M., Kimaru, L., et al. (2015). Implementation of an electronic fingerprint-linked data collection system: A feasibility and acceptability study among Zambian female sex workers. Global Health, 11(1), 27.

    Article  PubMed  PubMed Central  Google Scholar 

  • World Health Organization. (2015). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva

  • Yotebieng, M., Thirumurthy, H., Moracco, K. E., Edmonds, A., Tabala, M., Kawende, B., et al. (2016). Conditional cash transfers to increase retention in PMTCT Care, Antiretroviral adherence, and postpartum virological suppression. Journal of Acquired Immune Deficiency Syndromes, 72 S124–S129.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the contributions of the study participants and study site staff, without whom this research would not have been possible. This publication is based on research that has been supported in part by the University of Cape Town’s Research Committee (URC).

Funding

This work was supported by the US National Institutes of Health under grant K01 MH107256 (Clouse, PI) and grant UL1TR002243 to the Vanderbilt CTSA. This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the US Government.

Author information

Authors and Affiliations

  1. Division of Epidemiology and Biostatistics and Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Tamsin K. Phillips, Landon Myer & Zanele Rini

  2. Department of Psychology, Vanderbilt University, Nashville, TN, USA

    Kemberlee Bonnet & David Schlundt

  3. Witkoppen Health and Welfare Centre, Johannesburg, South Africa

    Sizakele Buthelezi & Jean Bassett

  4. Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA

    Kate Clouse

  5. Department of Medicine, Division of Infectious Diseases, Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Ave., Suite 750, Nashville, TN, 37203, USA

    Kate Clouse

Authors
  1. Tamsin K. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kemberlee Bonnet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Landon Myer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sizakele Buthelezi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zanele Rini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean Bassett
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Schlundt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kate Clouse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kate Clouse.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Phillips, T.K., Bonnet, K., Myer, L. et al. Acceptability of Interventions to Improve Engagement in HIV Care Among Pregnant and Postpartum Women at Two Urban Clinics in South Africa. Matern Child Health J 23, 1260–1270 (2019). https://doi.org/10.1007/s10995-019-02766-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-019-02766-9

Keywords

Search

Navigation