Browsing by Author "Stinson, Kathryn"

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    Acceptability, feasibility and impact of routine screening to detect undiagnosed HIV infection in 17 - 24-month-old children in the western sub-district of Cape Town
    (2012) Levin, Michael; Mathema, Hlengani; Stinson, Kathryn; Jennings, Karen
    OBJECTIVES: To explore the acceptability and feasibility of routine HIV screening in children at primary healthcare clinics and ascertain the prevalence of previously undiagnosed HIV infection in 17 - 24 month old children accessing curative and routine services. METHODS: A survey was conducted in 4 primary health clinics in the western sub-district of Cape Town. Rapid HIV screening of 17 - 24 month old children was performed for consenting caregiver-child pairs. Data on demographics, child health and antenatal history were collected using questionnaires. RESULTS: During recruitment, 358 children (72%) were tested for HIV infection. Most of the children (95.8%) were accompanied by a parent. The prevalence of reported HIV exposure among children was 21% (107/499). Of these, 3 had previously confirmed HIV infection; 1 was reportedly confirmed by a 6-week HIV test, and the other 2 probably contracted the virus via late post-partum transmission. The overall transmission rate was 3.5% (3/86) and the confirmed proportion of HIV-infected children was 0.8% (3/361). No previously unknown HIV infection was detected. CONCLUSIONS: Programmes to prevent mother-to-child transmission are effective, but at-risk infants who test negative at 6 weeks should be monitored for subsequent seroconversion. Parents of HIV-exposed infants are more likely to permit (re)testing of their infants than those whose offspring are not at risk. Routine HIV testing of children is feasible and acceptable at primary level, but may require additional resources to achieve universal coverage. Routine screening at an earlier age may detect previously undiagnosed HIV infection.
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    A case study of the drivers and barriers of implementation of the Baby Friendly Hospital Initiative (BFHI) within a rural sub-district in South Africa
    (2015) Brittin, Katherine; Stinson, Kathryn; Olivier, Jill
    Exclusive breastfeeding is recognised as a key child survival strategy in the South African context and the Baby Friendly Hospital Initiative (BFHI) accreditation for maternity facilities is recommended by the National Department of Health (NDOH) as crucial to improving the standards of care required for optimal support for mothers to successfully breastfeed. The Cape Winelands District in the Western Cape is a region that needs to improve the accreditation rate for its facilities. Key informant interviews were conducted within rural maternity services in the Breede Valley Sub-District. Interviews identified the barriers and enablers related to the health system building block 'information'. An additional goal was to examine communication and how information was disseminated throughout all levels of the health system to achieve the aim of successful policy implementation of the BFHI. Findings demonstrated that personal experiences of healthcare personnel may impact on the information offered to mothers. In addition, the operational manager of a facility possessed significant influence to ensure a policy was implemented and adhered to. Recommendations include advocating for education promoting breastfeeding in all healthcare programmes especially during the antenatal period by providing consistent, non-conflicting messages. Management should provide vision and strong leadership around implementation of the BFHI policy and ensure effective communication strategies around significant changes in the policy. Implementing BFHI is a complex context specific activity and to ensure optimal implementation of "Step three" (inform pregnant women of the benefits and management of breastfeeding) it is necessary to examine this particular area by using the recommendations as a framework in order to probe further.
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    Effects of HIV exposure on child growth in the Free State & Western Cape Provinces, South Africa
    (2013) Mathema, Hlengani T; Stinson, Kathryn
    The aim of this analysis was to determine the effects of HIV exposure on child growth and nutritional status in children less than two years of age in the Free State (FS) and Western Cape (WC) Provinces, South Africa.
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    Evaluating viral load monitoring in antiretroviral-experienced HIV-positive pregnant women accessing antenatal care in Khayelitsha, Cape Town
    (2015) Cragg, Carol Diane; Stinson, Kathryn; Giddy, Janet
    BACKGROUND: A viral load monitoring algorithm in the 2013 Western Cape Department of Health PMTCT guidelines include VL measurement in women who are antiretroviral (ART)-experienced at presentation for antenatal care, the timing of subsequent VL measurements and criteria for regimen change. The study evaluates the implementation of the algorithm in women who are virologically nonsuppressed and determines the outcomes of virological resuppression and infant PCR status. METHODS: This retrospective cohort study focused on all ART-experienced women who presented for antenatal care at one of two primary level Maternity Obstetric Units (MOUs) in Khayelitsha, Cape Town between July 2013 and June 2014. The study used routine data from facility registers, clinical records and electronic monitoring systems at the MOU, and referral ART sites and hospitals. Data collected included age, ART clinic, start date and regimen, and maternal VL and infant PCR results. RESULTS: Forty percent of the 1412 HIV-positive pregnant women, were ART-experienced, of whom 14.1 % were VNS. Predictors of being VNS included a duration on ART of more than 4 years (p= 0.04), attending an ART clinic other than that in the facility (p= 0.02), being on a second-line ART regimen (p=0.07) and being younger than 25 years (p= 0.05). The algorithm was correctly followed in up to 87.5% of women identified as VNS. The rate of virological resuppression by three months postpartum was 70.0% to 82.3%. Excluding three neonates who died, all of the 82.2% of infants tested were PCR negative. CONCLUSIONS: Nearly 15% of ART-experienced women were virologically nonsuppressed on presentation for antenatal care. Levels of adherence to the guideline, and virological resuppression rates of up to 82.3% are encouraging. The implementation of the VLM algorithm could be improved by the integration of obstetric and ART care, the adoption of a single electronic monitoring system and the use of standardised integrated clinical stationery.
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    An evaluation of the quality of antenatal care and patient satisfaction in two provinces of South Africa
    (2011) Besada, Donnela; Stinson, Kathryn; Coetzee, David; Little, Francesca
    The aim of this study was to investigate the quality of service delivery for HIV-infected women at antenatal clinics in the Western Cape and Free State provinces, South Africa and to highlight areas for improvement. It was part of a larger one to determine the effectiveness of PMTCT programmes in 4 countries. These two provinces were selected because the researchers had access to facilities there. The population included all clinics with antenatal services in these provinces. Pregnant women attending the clinics were selected to assess care at these services. The sampling frame for the facility survey consisted of the antenatal clinics that referred patients to the delivery sites where the first component of the PEARL study, a cord blood surveillance exercise had taken place.
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    Factors associated with Nevirapine adherence in the prevention of mother-to-child transmission of HIV in the Free State province of South Africa and discrepancies between service records and cord-blood surveillance
    (2014) Ngandu, Nobubelo Kwanele; Stinson, Kathryn
    Sub-Saharan Africa holds 90% of the HIV-infected children worldwide and most of them are infected through vertical transmission. The elimination of mother-to-child transmission of HIV in this region can be achieved through complementing prophylaxis regimens with effective service delivery. The latter should involve reaching all those at risk and optimizing adherence through adequate and routine follow-up. A study set out to assess the effectiveness of preventing mother-to-child transmission (PMTCT) programs in four African countries including South Africa using the simple nevirapine-based PMTCT regimen, found that prophylaxis coverage for the PMTCT of HIV was on average poor, at only 50% among HIV-exposed infants during 2007-2008. Incomplete HIV testing in pregnancy accounted for 46% of missed opportunities for PMTCT intervention. In addition, discrepancies were found between data from cord-blood samples, which are the gold standard measure of ingestion of the prophylaxis by mothers and routinely collected data on the provision of prophylaxis at antenatal clinics. Clinic records overestimated adherence to prophylaxis which could mislead decisions about service delivery. Adherence to the simple nevirapine regimen, data and service quality should be investigated in order to identify needs for strengthening the effectiveness of WHO Option B guidelines which are being rolled out in resource-poor settings. This project set out to assess the extent of clinic-level PMTCT prophylaxis coverage in the resource-limited setting of the Free State province. Adherence to treatment as well as accuracy of clinic records so as to inform better service implementation were measured. A total of 1572 mother-infant pairs were included in a cross-sectional survey carried out in rural antenatal and delivery services from two health districts between 2007 and 2008. HIV testing and nevirapine prophylaxis data were collected by nurses and compared to anonymously linked cord-blood tests which confirmed true HIV status and ingestion of nevirapine. Logistic regression was used to assess variables from the clinic surveillance data: age, gravidity, mode of delivery, timing of HIV testing and number of antenatal visits during pregnancy, as potential predictors of adherence to nevirapine. The Kappa statistic revealed a disagreement of 10% in HIV test results and 20% in nevirapine intake between clinic records and cord-blood. The clinic records under-estimated maternal HIV prevalence by 9% (22% records versus 31% cord-blood) in mothers aged between 12 and 43 years. Also, cord-blood surveillance revealed that 19.4% of the HIV positive women recorded to have been offered nevirapine during labor, did not actually ingest it. The more frequently a woman sought antenatal care during pregnancy, the more likely she was to ingest nevirapine. Women who had at least 4 antenatal visits were 4.5 times more likely to adhere than women who attended services only once. Even though this is the simplest regimen for preventing vertical HIV transmission, compliance to the entire antenatal cascade during pregnancy is important in improving adherence to therapy and preventing missed opportunities for intervention. Inaccurate collection of routine clinic data negatively impacts on routinely reported data outcomes. Major improvements need to be undertaken both at the service provider and user levels in order to ensure that the effectiveness of the new Option-B guidelines are optimal in remote settings.
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    Factors influencing male involvement in prevention of mother-to-child transmission services in Khayelitsha, Cape Town, South Africa
    (2011) Ladur, Alice Norah; Colvin, Christopher J; Stinson, Kathryn
    This study sought to explore the role of men in the prevention of mother-to-child transmission services in Khayelitsha, South Africa. Two focus group discussions were held with 25 men of unknown status and one focus group discussion held with 12 HIV-positive women in the community. In-depth interviews were also conducted with four HIV-positive couples and five service providers purposely sampled from the community and a health facility, respectively.
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    From lost to found: the silent transfer of patients on Antiretroviral Therapy in Khayelitsha, South Africa
    (2016) Hennessey, Claudine; Stinson, Kathryn
    Incorrect classification of silent transfer (STF) patients as lost to follow-up (LTF) negatively impacts accurate assessment of retention in care for antiretroviral (ART) programmes. Understanding reasons why patients STF and what proportion of LTF patients constitute this silent transfer phenomenon is necessary to ensure patient continuity of care. We attempted to identify STF patients using the routine government electronic monitoring systems. Furthermore, we sought to identify potential reasons for the STF phenomenon through patient surveys and healthcare provider interviews, in order to guide policy and improve programmatic outcomes. In this mixed methods approach, we selected patients identified as LTF between 2008-2012 in three health facilities from Khayelitsha, Western Cape. Identified patients were subsequently searched for using a combined provincial patient data set. Once consent was obtained, sampling of patients and healthcare providers, using convenience and snowballing methods respectively, were selected for participation. Ninety percent of patients believe it necessary to inform facility staff of the intent to transfer, 56% of patients interviewed cited fear of negative attitudes from staff regarding transfer request (65%), family situations (30%), and long waiting times (11%) as contributing factors to silently transferring care between facilities. Healthcare providers cited stigma, family obligations and/or support, and migration to the Eastern Cape as main reasons for patients transferring. Healthcare providers cited incomplete or lack of transfer documentation as the biggest barrier to timeous treatment of the transfer patient. Incorrect reporting of patients as lost to follow-up negatively affects the treatment programmes retention in care. Negative staff attitudes and poor operational services prevent patients informing staff of transfer intent. The treatment programme must adapt current transfer policies in order to facilitate the transfer process for all patients, including those experiencing emergencies and life events. Linked electronic patient monitoring systems will improve accurate retention in care reporting and improve fluidity of transferring of patients between health services.
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    Health care providers' attitudes towards termination of pregnancy: A qualitative study in South Africa
    (BioMed Central Ltd, 2009) Harries, Jane; Stinson, Kathryn; Orner, Phyllis
    BACKGROUND:Despite changes to the abortion legislation in South Africa in 1996, barriers to women accessing abortion services still exist including provider opposition to abortions and a shortage of trained and willing abortion care providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.In South Africa, little is known about the personal and professional attitudes of individuals who are currently working in abortion service provision. Exploring the factors which determine health care providers' involvement or disengagement in abortion services may facilitate improvement in the planning and provision of future services. METHODS: Qualitative research methods were used to collect data. Thirty four in-depth interviews and one focus group discussion were conducted during 2006 and 2007 with health care providers who were involved in a range of abortion provision in the Western Cape Province, South Africa. Data were analysed using a thematic analysis approach. RESULTS: Complex patterns of service delivery were prevalent throughout many of the health care facilities, and fragmented levels of service provision operated in order to accommodate health care providers' willingness to be involved in different aspects of abortion provision. Related to this was the need expressed by many providers for dedicated, stand-alone abortion clinics thereby creating a more supportive environment for both clients and providers. Almost all providers were concerned about the numerous difficulties women faced in seeking an abortion and their general quality of care. An overriding concern was poor pre and post abortion counselling including contraceptive counselling and provision. CONCLUSION: This is the first known qualitative study undertaken in South Africa exploring providers' attitudes towards abortion and adds to the body of information addressing the barriers to safe abortion services. In order to sustain a pool of abortion providers, programmes which both attract prospective abortion providers, and retain existing providers, needs to be developed and financial compensation for abortion care providers needs to be considered.
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    Health facility characteristics and their relationship to coverage of PMTCT of HIV services across four African countries: the PEARL study
    (Public Library of Science, 2012) Ekouevi, Didier K; Stringer, Elizabeth; Coetzee, David; Tih, Pius; Creek, Tracy; Stinson, Kathryn; Westfall, Andrew O; Welty, Thomas; Chintu, Namwinga; Chi, Benjamin H
    BACKGROUND: Health facility characteristics associated with effective prevention of mother-to-child transmission of HIV (PMTCT) coverage in sub-Saharan are poorly understood. METHODOLOGY/PRINCIPAL FINDINGS: We conducted surveys in health facilities with active PMTCT services in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Data was compiled via direct observation and exit interviews. We constructed composite scores to describe provision of PMTCT services across seven topical areas: antenatal quality, PMTCT quality, supplies available, patient satisfaction, patient understanding of medication, and infrastructure quality. Pearson correlations and Generalized Estimating Equations (GEE) to account for clustering of facilities within countries were used to evaluate the relationship between the composite scores, total time of visit and select individual variables with PMTCT coverage among women delivering. Between July 2008 and May 2009, we collected data from 32 facilities; 78% were managed by the government health system. An opt-out approach for HIV testing was used in 100% of facilities in Zambia, 63% in Cameroon, and none in Côte d'Ivoire or South Africa. Using Pearson correlations, PMTCT coverage (median of 55%, (IQR: 33-68) was correlated with PMTCT quality score (rho = 0.51; p = 0.003); infrastructure quality score (rho = 0.43; p = 0.017); time spent at clinic (rho = 0.47; p = 0.013); patient understanding of medications score (rho = 0.51; p = 0.006); and patient satisfaction quality score (rho = 0.38; p = 0.031). PMTCT coverage was marginally correlated with the antenatal quality score (rho = 0.304; p = 0.091). Using GEE adjustment for clustering, the, antenatal quality score became more strongly associated with PMTCT coverage (p<0.001) and the PMTCT quality score and patient understanding of medications remained marginally significant. Conclusions/RESULTS: We observed a positive relationship between an antenatal quality score and PMTCT coverage but did not identify a consistent set of variables that predicted PMTCT coverage.
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    'I know that I do have HIV but nobody saw me': oral HIV self-testing in an informal settlement in South Africa
    (Public Library of Science, 2016) Pérez, Guillermo Martínez; Cox, Vivian; Ellman, Tom; Moore, Ann; Patten, Gabriela; Shroufi, Amir; Stinson, Kathryn; Cutsem, Gilles Van; Ibeto, Maryrene
    Reaching universal HIV-status awareness is crucial to ensure all HIV-infected patients access antiretroviral treatment (ART) and achieve virological suppression. Opportunities for HIV testing could be enhanced by offering self-testing in populations that fear stigma and discrimination when accessing conventional HIV Counselling and Testing (HCT) in health care facilities. This qualitative research aims to examine the feasibility and acceptability of unsupervised oral self-testing for home use in an informal settlement of South Africa. Eleven in-depth interviews, two couple interviews, and two focus group discussions were conducted with seven healthcare workers and thirteen community members. Thematic analysis was done concurrently with data collection. Acceptability to offer home self-testing was demonstrated in this research. Home self-testing might help this population overcome barriers to accepting HCT; this was particularly expressed in the male and youth groups. Nevertheless, pilot interventions must provide evidence of potential harm related to home self-testing, intensify efforts to offer quality counselling, and ensure linkage to HIV/ART-care following a positive self-test result.
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    Improving men's participation in preventing mother-to-child transmission of HIV as a maternal, neonatal, and child health priority in South Africa
    (Public Library of Science, 2015) van den Berg, Wessel; Brittain, Kirsty; Mercer, Gareth; Peacock, Dean; Stinson, Kathryn; Janson, Hanna; Dubula, Vuyiseka
    Wessel van den Berg and colleagues outline how increasing male partner involvement in efforts to reduce mother-to-child HIV transmission in South Africa may improve maternal and infant outcomes.
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    Integration of antiretroviral therapy services into antenatal care increases treatment initiation during pregnancy: a cohort study
    (Public Library of Science, 2013) Stinson, Kathryn; Jennings, Karen; Myer, Landon
    Objectives Initiation of antiretroviral therapy (ART) during pregnancy is critical to promote maternal health and prevent mother-to-child HIV transmission (PMTCT). The separation of services for antenatal care (ANC) and ART may hinder antenatal ART initiation. We evaluated ART initiation during pregnancy under different service delivery models in Cape Town, South Africa. METHODS: A retrospective cohort study was conducted using routinely collected clinic data. Three models for ART initiation in pregnancy were evaluated ART ‘integrated’ into ANC, ART located ‘proximal’ to ANC, and ART located some distance away from ANC (‘distal’). Kaplan-Meier methods and Poisson regression were used to examine the association between service delivery model and antenatal ART initiation. RESULTS: Among 14 617 women seeking antenatal care in the three services, 30% were HIV-infected and 17% were eligible for ART based on CD4 cell count <200 cells/µL. A higher proportion of women started ART antenatally in the integrated model compared to the proximal or distal models (55% vs 38% vs 45%, respectively, global p = 0.003). After adjusting for age and gestation at first ANC visit, women who at the integrated service were significantly more likely to initiate ART antenatally (rate ratio 1.33; 95% confidence interval: 1.09-1.64) compared to women attending the distal model; there was no difference between the proximal and distal models in antenatal ART initiation however (p = 0.704). CONCLUSIONS: Integration of ART initiation into ANC is associated with higher levels of ART initiation in pregnancy. This and other forms of service integration may represent a valuable intervention to enhance PMTCT and maternal health.
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    Male partner involvement during pregnancy the missing component in PMTCT adherence in Khayelitsha
    (2014) Brittain, Kirsty; Stinson, Kathryn
    Includes abstract. Includes bibliographical references.
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    Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries
    (Public Library of Science, 2013) Stringer, Jeffrey S A; Stinson, Kathryn; Tih, Pius M; Giganti, Mark J; Ekouevi, Didier K; Creek, Tracy L; Welty, Thomas K; Chi, Benjamin H; Wilfert, Catherine M; Shaffer, Nathan
    BACKGROUND: Population-based evaluations of programs for prevention of mother-to-child HIV transmission (PMTCT) are scarce. We measured PMTCT service coverage, regimen use, and HIV-free survival among children ≤24 mo of age in Cameroon, Côte D'Ivoire, South Africa, and Zambia. Methods and FINDINGS: We randomly sampled households in 26 communities and offered participation if a child had been born to a woman living there during the prior 24 mo. We tested consenting mothers with rapid HIV antibody tests and tested the children of seropositive mothers with HIV DNA PCR or rapid antibody tests. Our primary outcome was 24-mo HIV-free survival, estimated with survival analysis. In an individual-level analysis, we evaluated the effectiveness of various PMTCT regimens. In a community-level analysis, we evaluated the relationship between HIV-free survival and community PMTCT coverage (the proportion of HIV-exposed infants in each community that received any PMTCT intervention during gestation or breastfeeding). We also compared our community coverage results to those of a contemporaneous study conducted in the facilities serving each sampled community. Of 7,985 surveyed children under 2 y of age, 1,014 (12.7%) were HIV-exposed. Of these, 110 (10.9%) were HIV-infected, 851 (83.9%) were HIV-uninfected, and 53 (5.2%) were dead. HIV-free survival at 24 mo of age among all HIV-exposed children was 79.7% (95% CI: 76.4, 82.6) overall, with the following country-level estimates: Cameroon (72.6%; 95% CI: 62.3, 80.5), South Africa (77.7%; 95% CI: 72.5, 82.1), Zambia (83.1%; 95% CI: 78.4, 86.8), and Côte D'Ivoire (84.4%; 95% CI: 70.0, 92.2). In adjusted analyses, the risk of death or HIV infection was non-significantly lower in children whose mothers received a more complex regimen of either two or three antiretroviral drugs compared to those receiving no prophylaxis (adjusted hazard ratio: 0.60; 95% CI: 0.34, 1.06). Risk of death was not different for children whose mothers received a more complex regimen compared to those given single-dose nevirapine (adjusted hazard ratio: 0.88; 95% CI: 0.45, 1.72). Community PMTCT coverage was highest in Cameroon, where 75 of 114 HIV-exposed infants met criteria for coverage (66%; 95% CI: 56, 74), followed by Zambia (219 of 444, 49%; 95% CI: 45, 54), then South Africa (152 of 365, 42%; 95% CI: 37, 47), and then Côte D'Ivoire (3 of 53, 5.7%; 95% CI: 1.2, 16). In a cluster-level analysis, community PMTCT coverage was highly correlated with facility PMTCT coverage (Pearson's r  = 0.85), and moderately correlated with 24-mo HIV-free survival (Pearson's r  = 0.29). In 14 of 16 instances where both the facility and community samples were large enough for comparison, the facility-based coverage measure exceeded that observed in the community. CONCLUSIONS: HIV-free survival can be estimated with community surveys and should be incorporated into ongoing country monitoring. Facility-based coverage measures correlate with those derived from community sampling, but may overestimate population coverage. The more complex regimens recommended by the World Health Organization seem to have measurable public health benefit at the population level, but power was limited and additional field validation is needed. Please see later in the article for the Editors' Summary
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    A mixed methods study to explore the outcomes, experiences and perceptions of women who attended a new counselling model for HIV-positive pregnant women accessing antenatal services in Khayelitsha, Cape Town, South Africa
    (2016) Kirya, Viola; Stinson, Kathryn
    Objectives: The aim of this study was to explore the experiences and perceptions of counsellors and patients towards a new counselling model for HIV-positive pregnant women on Option B+ at an antenatal clinic in South Africa and to describe the cohort of HIV-positive pregnant women who experienced the new counselling model. Methods: A mixed methods study design was employed. The quantitative data collection involved using retrospective cohort quantitative data of women that were initiated on Option B+ during the period of 1 October 2013 to 30 June 2014. The variables of interest included: age, gravidity, antiretroviral therapy initiation date, viral load result and number of counselling sessions completed. These were obtained from patient folders and from the Department of Health patient electronic health record. The data was analysed using STATA 12. The qualitative data involved semi-structured interviews of patients and counsellors who had experienced the counselling model. Results: The number of women who completed a total of 1, 2, 3 or 4 counselling sessions was 25%, 26%, 48% and 1% respectively. The percentage of women that were retained in care for more than 8 weeks postnatal was 53%. Of the women with VL results, 92% were virally suppressed. The Fisher's exact test showed a P-value of 0.05 at a level of significance of P ≤ 0.05. Therefore there is sufficient evidence to show that there is a positive association between the number of counselling sessions completed and number of postnatal days in care. The study also found that from the counselling, the women gained social support, knowledge about: antiretroviral therapy, HIV, drug side effects and infant feeding. Conclusion: The poor uptake of the counselling intervention includes poor communication, service delivery challenges and social factors. The main motivation for initiating ART and maintaining adherence to treatment was to protect the baby and as a result, some women maintained adherence despite not completing the counselling. Women valued the education that they received during the counselling sessions and this influenced their adherence. Psychosocial support from the counsellors and peers was found to be vital to the women and this highlighted the need to incorporate a support group for the pregnant women, as part of the intervention. The findings also suggest that when offering counselling interventions to pregnant women, a balance between psychosocial support, practical support and patient education needs to be struck. Finally, education of the community on the importance of counselling is important in order to improve the uptake of the counselling because interventions aimed at mothers do not always take into account the influence of the social environment on the uptake of the intervention.
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    Perceptions of community members and healthcare workers on male involvement in prevention of mother-to-child transmission services in Khayelitsha, Cape Town, South Africa
    (Public Library of Science, 2015) Ladur, Alice Norah; Colvin, Christopher J; Stinson, Kathryn
    Involving male partners of pregnant women accessing PMTCT programs has the potential to improve health outcomes for women and children. This study explored community members' (men and women) and healthcare workers' perceptions of male involvement in the prevention of mother-to-child transmission of HIV in Khayelitsha, South Africa. Two focus group discussions were held with 25 men of unknown HIV status and one focus group discussion held with 12 HIV-positive women in the community. In depth interviews were conducted with four HIV-positive couples and five service providers purposely sampled from the community and a health facility, respectively. Both men and women interviewed in this study were receptive towards male involvement in PMTCT. However, men were reluctant to engage with health services due to stigma and negative attitudes from nurses. This study also found HIV testing, disclosure and direct health worker engagement with men increases male involvement in PMTCT. Using men in the media and community to reach out to fellow men with prevention messages tailored to suit specific audiences may reduce perceptions of antenatal care as being a woman's domain.