Department of Public and Environmental Wellness, Oakland University, School of Health Sciences, 3101 Human Health Building, 433 Meadow Brook Rd, Rochester, MI, 48309-4452, USA.
Center for Learning and Childhood Development-Ghana, AF, 3190, Adenta Flats, Accra, Ghana.
BMC Pregnancy Childbirth. 2020 Jul 17;20(1):398. doi: 10.1186/s12884-020-03067-8.
Maternal retention in HIV care is lower for women in the postpartum period than during pregnancy, but the reasons are poorly understood. We examined key differences in barriers to retention in HIV care during and after pregnancy.
We conducted semi-structured, in-depth interviews with 30 postpartum women living with HIV. Participants were recruited from two tertiary facilities implementing Option B+ for prevention of mother-to-child HIV transmission in Accra, Ghana. We collected data from mothers who had disengaged from HIV care and those who were still engaged in care. The interviews were analyzed using principles adapted from grounded theory.
Participants' experiences and narratives showed that retention in HIV care was more challenging during the postpartum period than during pregnancy. Poor maternal physical health (from birth complications and cesarean section), socio-cultural factors (norms about newborn health and pregnancy), and economic difficulties linked to childbirth (such as unemployment, under-employment, and debt) made the costs of retention in HIV care more economically and socially expensive in the postpartum period than during pregnancy. Some participants also shared that transportation costs and resulting dependence on a partner to pay increased during the postpartum period because of a strong shift in maternal preference for private modes of transportation due to HIV stigma and the desire to protect the newborn. These factors played a larger role in the postpartum period than during pregnancy and created a significant barrier to retention. A conceptual model of how these factors interrelate, the synergy between them, and how they affect retention in the postpartum period is presented.
In Ghana, lower retention in HIV care in the postpartum period compared to in pregnancy may be primarily driven by social, economic, and newborn health factors. Multifaceted economic-based and stigma-reduction interventions are needed to increase retention in maternal HIV care after childbirth.
与怀孕期间相比，产后母婴 HIV 护理中产妇的保留率较低，但原因尚不清楚。我们研究了怀孕期间和之后阻碍 HIV 护理保留的关键差异。
我们对加纳阿克拉的两家三级医疗机构中实施预防母婴传播选项 B+的 30 名产后 HIV 感染者进行了半结构式深入访谈。我们从已经脱离 HIV 护理和仍在接受护理的母亲中收集了数据。访谈采用扎根理论改编的原则进行分析。
参与者的经验和叙述表明，产后 HIV 护理的保留率比怀孕期间更具挑战性。产妇身体状况不佳（分娩并发症和剖腹产）、社会文化因素（新生儿健康和怀孕的规范）以及与分娩相关的经济困难（如失业、就业不足和债务）使得产后 HIV 护理的保留成本比怀孕期间更加昂贵。一些参与者还表示，由于 HIV 污名化和保护新生儿的愿望导致对私人交通方式的偏好增强，以及产后交通成本增加和对伴侣的依赖增加，交通成本在产后期间有所增加。这些因素在产后期间比怀孕期间发挥更大的作用，成为保留的重要障碍。提出了一个概念模型，说明这些因素如何相互关联、相互作用以及如何影响产后保留率。
在加纳，与怀孕期间相比，产后 HIV 护理保留率较低可能主要是由社会、经济和新生儿健康因素驱动的。需要采取多方面的基于经济和减少污名的干预措施，以增加产后母婴 HIV 护理的保留率。
