A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women

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dc.contributor.authorHodgson, Ianen_ZA
dc.contributor.authorPlummer, Mary Len_ZA
dc.contributor.authorKonopka, Sarah Nen_ZA
dc.contributor.authorColvin, Christopher Jen_ZA
dc.contributor.authorJonas, Ednaen_ZA
dc.contributor.authorAlbertini, Jenniferen_ZA
dc.contributor.authorAmzel, Anouken_ZA
dc.contributor.authorFogg, Karen Pen_ZA
dc.date.accessioned2015-11-16T04:09:39Z
dc.date.available2015-11-16T04:09:39Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. METHODS: Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. RESULTS: Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman’s awareness and control (e.g., commitment to child’s health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. CONCLUSIONS: To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.en_ZA
dc.identifier.apacitationHodgson, I., Plummer, M. L., Konopka, S. N., Colvin, C. J., Jonas, E., Albertini, J., ... Fogg, K. P. (2014). A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women. <i>PLoS One</i>, http://hdl.handle.net/11427/15002en_ZA
dc.identifier.chicagocitationHodgson, Ian, Mary L Plummer, Sarah N Konopka, Christopher J Colvin, Edna Jonas, Jennifer Albertini, Anouk Amzel, and Karen P Fogg "A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/15002en_ZA
dc.identifier.citationHodgson, I., Plummer, M. L., Konopka, S. N., Colvin, C. J., Jonas, E., Albertini, J., ... & Fogg, K. P. (2013). 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. doi:10.1371/journal.pone.0111421en_ZA
dc.identifier.ris TY - Journal Article AU - Hodgson, Ian AU - Plummer, Mary L AU - Konopka, Sarah N AU - Colvin, Christopher J AU - Jonas, Edna AU - Albertini, Jennifer AU - Amzel, Anouk AU - Fogg, Karen P AB - BACKGROUND: Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. METHODS: Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. RESULTS: Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman’s awareness and control (e.g., commitment to child’s health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. CONCLUSIONS: To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0111421 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women TI - A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women UR - http://hdl.handle.net/11427/15002 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15002
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0111421
dc.identifier.vancouvercitationHodgson I, Plummer ML, Konopka SN, Colvin CJ, Jonas E, Albertini J, et al. A Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Women. PLoS One. 2014; http://hdl.handle.net/11427/15002.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2014 Hodgson et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherPregnancyen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherQualitative studiesen_ZA
dc.subject.otherHealth services researchen_ZA
dc.titleA Systematic Review of Individual and Contextual Factors Affecting ART Initiation, Adherence, and Retention for HIV-Infected Pregnant and Postpartum Womenen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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