Tuesday, March 1, 2016

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

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.

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.

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.

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
ReasonsYes, n*Yes, %Rank
Fell asleep/slept through the dose time221001
Ran out of pills2090.92
Simply forget1881.83
Did not want others to notice me while taking the ARV medication1568.24
Was away from home1463.65
Was busy with other things1359.16
Had a change in daily routine1254.57
Felt sick or ill1150.08
Wanted a break from thinking about HIV940.99
Felt good836.410
Felt depressed/overwhelmed731.811
Drank alcohol522.712
Wanted to avoid side effects418.213
Thought medicine would work just as well418.213
Felt like drug was toxic/harmful418.213
Had difficulty taking pills because of taste or size313.614
Took drug/Indian hemp313.614
Had too many pills to take14.515
Lost/stolen ARV14.515
Used CAM instead00
Has problems taking pills at specified time (with meals, on empty stomach)00
Had misunderstood the information about medications or dosing00
Had a poor relationship with your physician00
Sold ARV00
Reasons for missing infant prophylaxis
Home delivery1150.01
Delivery at other hospital836.42
Mother refused to give NVP for fear of someone finding/seeing NVP522.73
NVP syrup spilled418.24
NVP not available at the delivery room (deliveries happened over the weekend)313.65
I forgot29.16
Baby did not tolerate NVP and I did not inform the health worker29.16
*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

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

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