Barriers to Uptake of Prevention of Mother-To-Child Transmission of HIV Services among Mothers of Vertically Infected HIV-Seropositive Infants in Makurdi, Nigeria

BACKGROUND:

Perinatal transmission of human immunodeficiency virus (HIV) continues in Nigeria because of the poor use of prevention of mother-to-child transmission of HIV (PMTCT) services. This study reports on the barriers preventing mothers of vertically infected HIV-seropositive infants to use the PMTCT services at the Federal Medical Centre, Makurdi, Nigeria.

METHODS:

This is a descriptive study conducted between January and April, 2014. A quantitative survey was applied to detect barriers along the PMTCT services cascade among 52 mothers of vertically infected HIV-seropositive infants. This includes 22 women who attended antenatal care at the Federal Medical Centre (designated as Group A mothers) and 30 women who did not receive any form of PMTCT service (Group B mothers). The study was supplemented with a focused group discussion involving 12 discussants from the two groups.

RESULTS:

In the quantitative assessment: among the Group A mothers, falling asleep was the most common reason (n=22, 100%) for missing therapeutic/prophylactic antiretroviral medicine; financial constraint (n=22, 100%) was the most common reason for antenatal care visit defaults; and a lot of the mothers (n=11, 50.0%) did not give nevirapine to their newborns because they delivered at home. Among Group B mothers, unawareness of HIV-seropositive status was the most common reason (n=28, 93.3%) given for not accessing PMTCT services. In the qualitative study: noninvolvement of male partners, stigma and discrimination experienced by HIV-seropositive mothers, financial constraints in couples, involvement of traditional birth attendants in antenatal care and delivery of HIV-infected women, unawareness of HIV-seropositive status by pregnant women, poor health system, and the lack of funding for PMTCT services at private and rural health facilities were the major barriers preventing the use of PMTCT services.

CONCLUSION:

In order to reduce the missed opportunities for PMTCT interventions in Makurdi and by extension the Benue State it represents in Nigeria, strong political and financial commitments are needed to overcome the identified barriers.

Reasons for suboptimal adherence on ARV medicine among the 22 Group A mothers and reasons why their infants missed the NVP prophylaxes

Reasons	Yes, n*	Yes, %	Rank
Fell asleep/slept through the dose time	22	100	1
Ran out of pills	20	90.9	2
Simply forget	18	81.8	3
Did not want others to notice me while taking the ARV medication	15	68.2	4
Was away from home	14	63.6	5
Was busy with other things	13	59.1	6
Had a change in daily routine	12	54.5	7
Felt sick or ill	11	50.0	8
Wanted a break from thinking about HIV	9	40.9	9
Felt good	8	36.4	10
Felt depressed/overwhelmed	7	31.8	11
Drank alcohol	5	22.7	12
Wanted to avoid side effects	4	18.2	13
Thought medicine would work just as well	4	18.2	13
Felt like drug was toxic/harmful	4	18.2	13
Had difficulty taking pills because of taste or size	3	13.6	14
Took drug/Indian hemp	3	13.6	14
Had too many pills to take	1	4.5	15
Lost/stolen ARV	1	4.5	15
Used CAM instead	0	0	–
Has problems taking pills at specified time (with meals, on empty stomach)	0	0	–
Had misunderstood the information about medications or dosing	0	0	–
Had a poor relationship with your physician	0	0	–
Sold ARV	0	0	–
Reasons for missing infant prophylaxis
Home delivery	11	50.0	1
Delivery at other hospital	8	36.4	2
Mother refused to give NVP for fear of someone finding/seeing NVP	5	22.7	3
NVP syrup spilled	4	18.2	4
NVP not available at the delivery room (deliveries happened over the weekend)	3	13.6	5
I forgot	2	9.1	6
Baby did not tolerate NVP and I did not inform the health worker	2	9.1	6

Note:

*Multiple responses possible.

Abbreviations: CAM, complementary and alternative medicine; ARV, antiretroviral medicine; NVP, nevirapine; HIV, human immunodeficiency virus.

Full article at:   http://goo.gl/oISR31

By:  Anígilájé EA1, Ageda BR2, Nweke NO1.

• 1Department of Paediatrics, Federal Medical Centre, Makurdi, Nigeria.
• 2Department of Obstetrics and Gynaecology, Federal Medical Centre, Makurdi, Nigeria. 
• Patient Prefer Adherence. 2016 Jan 27;10:57-72. doi: 10.2147/PPA.S87228. eCollection 2016.

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