‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda
| dc.contributor.author | Alhassan, Yussif | |
| dc.contributor.author | Twimukye, Adelline | |
| dc.contributor.author | Malaba, Thokozile | |
| dc.contributor.author | Myer, Landon | |
| dc.contributor.author | Waitt, Catriona | |
| dc.contributor.author | Lamorde, Mohammed | |
| dc.contributor.author | Colbers, Angela | |
| dc.contributor.author | Reynolds, Helen | |
| dc.contributor.author | Khoo, Saye | |
| dc.contributor.author | Taegtmeyer, Miriam | |
| dc.date.accessioned | 2022-10-24T10:07:23Z | |
| dc.date.available | 2022-10-24T10:07:23Z | |
| dc.date.issued | 2022-07-15 | |
| dc.date.updated | 2022-07-17T03:16:06Z | |
| dc.description.abstract | Background Many women in sub-Saharan Africa initiate antenatal care (ANC) late in pregnancy, undermining optimal prevention of mother-to-child-transmission (PMTCT) of HIV. Questions remain about whether and how late initiation of ANC in pregnancy is related to adherence to antiretroviral therapy (ART) in the era of national dolutegravir roll-out. Methods This study employed a qualitative design involving individual interviews and focus group discussions conducted between August 2018 and March 2019. We interviewed 37 pregnant and lactating women living with HIV selected purposively for early or late presentation to ANC from poor urban communities in South Africa and Uganda. Additionally, we carried out seven focused group discussions involving 67 participants in both countries. Data were analysed thematically in NVivo12. Results Women described common underlying factors influencing both late ANC initiation and poor ART adherence in South Africa and Uganda. These included poverty and time constraints; inadequate health knowledge; perceived low health risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes. Most late ANC presenters reported relationship problems, lack of autonomy and the limited ability to dialogue with their partners to influence household decisions on health and resource allocation. Perception of poor privacy and confidentiality in maternity clinics was rife among women in both study settings and compounded risks associated with early disclosure of pregnancy and HIV. Women who initiated ANC late and were then diagnosed with HIV appeared to be more susceptible to poor ART adherence. They were often reprimanded by health workers for presenting late which hampered their participation in treatment counselling and festered provider mistrust and subsequent disengagement in care. Positive HIV diagnosis in late pregnancy complicated women’s ability to disclose their status to significant others which deprived them of essential social support for treatment adherence. Further, it appeared to adversely affect women’s mental health and treatment knowledge and self-efficacy. Conclusions We found clear links between late initiation of ANC and the potential for poor adherence to ART based on common structural barriers shaping both health seeking behaviours, and the adverse impact of late HIV diagnosis on women’s mental health and treatment knowledge and efficacy. Women who present late are a potential target group for better access to antiretrovirals that are easy to take and decrease viral load rapidly, and counselling support with adherence and partner disclosure. A combination of strengthened health literacy, economic empowerment, improved privacy and patient-provider relationships as well as community interventions that tackle inimical cultural practices on pregnancy and unfair gender norms may be required. | en_US |
| dc.identifier.apacitation | Alhassan, Y., Twimukye, A., Malaba, T., Myer, L., Waitt, C., Lamorde, M., ... Taegtmeyer, M. (2022). ‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda. <i>BMC Pregnancy and Childbirth</i>, 22(1), 566. http://hdl.handle.net/11427/36871 | en_ZA |
| dc.identifier.chicagocitation | Alhassan, Yussif, Adelline Twimukye, Thokozile Malaba, Landon Myer, Catriona Waitt, Mohammed Lamorde, Angela Colbers, Helen Reynolds, Saye Khoo, and Miriam Taegtmeyer "‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda." <i>BMC Pregnancy and Childbirth</i> 22, 1. (2022): 566. http://hdl.handle.net/11427/36871 | en_ZA |
| dc.identifier.citation | Alhassan, Y., Twimukye, A., Malaba, T., Myer, L., Waitt, C., Lamorde, M., Colbers, A. & Reynolds, H. et al. 2022. ‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda. <i>BMC Pregnancy and Childbirth.</i> 22(1):566. http://hdl.handle.net/11427/36871 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Alhassan, Yussif AU - Twimukye, Adelline AU - Malaba, Thokozile AU - Myer, Landon AU - Waitt, Catriona AU - Lamorde, Mohammed AU - Colbers, Angela AU - Reynolds, Helen AU - Khoo, Saye AU - Taegtmeyer, Miriam AB - Background Many women in sub-Saharan Africa initiate antenatal care (ANC) late in pregnancy, undermining optimal prevention of mother-to-child-transmission (PMTCT) of HIV. Questions remain about whether and how late initiation of ANC in pregnancy is related to adherence to antiretroviral therapy (ART) in the era of national dolutegravir roll-out. Methods This study employed a qualitative design involving individual interviews and focus group discussions conducted between August 2018 and March 2019. We interviewed 37 pregnant and lactating women living with HIV selected purposively for early or late presentation to ANC from poor urban communities in South Africa and Uganda. Additionally, we carried out seven focused group discussions involving 67 participants in both countries. Data were analysed thematically in NVivo12. Results Women described common underlying factors influencing both late ANC initiation and poor ART adherence in South Africa and Uganda. These included poverty and time constraints; inadequate health knowledge; perceived low health risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes. Most late ANC presenters reported relationship problems, lack of autonomy and the limited ability to dialogue with their partners to influence household decisions on health and resource allocation. Perception of poor privacy and confidentiality in maternity clinics was rife among women in both study settings and compounded risks associated with early disclosure of pregnancy and HIV. Women who initiated ANC late and were then diagnosed with HIV appeared to be more susceptible to poor ART adherence. They were often reprimanded by health workers for presenting late which hampered their participation in treatment counselling and festered provider mistrust and subsequent disengagement in care. Positive HIV diagnosis in late pregnancy complicated women’s ability to disclose their status to significant others which deprived them of essential social support for treatment adherence. Further, it appeared to adversely affect women’s mental health and treatment knowledge and self-efficacy. Conclusions We found clear links between late initiation of ANC and the potential for poor adherence to ART based on common structural barriers shaping both health seeking behaviours, and the adverse impact of late HIV diagnosis on women’s mental health and treatment knowledge and efficacy. Women who present late are a potential target group for better access to antiretrovirals that are easy to take and decrease viral load rapidly, and counselling support with adherence and partner disclosure. A combination of strengthened health literacy, economic empowerment, improved privacy and patient-provider relationships as well as community interventions that tackle inimical cultural practices on pregnancy and unfair gender norms may be required. DA - 2022-07-15 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - https://bmcpregnancychildbirth.biomedcentral.com/ KW - Antenatal care KW - Antiretroviral therapy KW - Adherence to antiretroviral therapy KW - Dolutegravir KW - Antenatal care initiation KW - Booking KW - Women living with HIV KW - Uganda KW - South Africa LK - https://open.uct.ac.za PY - 2022 T1 - ‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda TI - ‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda UR - http://hdl.handle.net/11427/36871 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12884-022-04896-5 | |
| dc.identifier.uri | http://hdl.handle.net/11427/36871 | |
| dc.identifier.vancouvercitation | Alhassan Y, Twimukye A, Malaba T, Myer L, Waitt C, Lamorde M, et al. ‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda. BMC Pregnancy and Childbirth. 2022;22(1):566. http://hdl.handle.net/11427/36871. | en_ZA |
| dc.language.iso | en | en_US |
| dc.language.rfc3066 | en | |
| dc.publisher.department | Department of Public Health and Family Medicine | en_US |
| dc.publisher.faculty | Faculty of Health Sciences | en_US |
| dc.rights.holder | The Author(s) | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_US |
| dc.source | BMC Pregnancy and Childbirth | |
| dc.source.journalissue | 1 | en_US |
| dc.source.journalvolume | 22 | en_US |
| dc.source.pagination | 566 | en_US |
| dc.source.uri | https://bmcpregnancychildbirth.biomedcentral.com/ | |
| dc.source.uri | https://bmcpregnancychildbirth.biomedcentral.com/ | |
| dc.subject | Antenatal care | en_US |
| dc.subject | Antiretroviral therapy | en_US |
| dc.subject | Adherence to antiretroviral therapy | en_US |
| dc.subject | Dolutegravir | en_US |
| dc.subject | Antenatal care initiation | en_US |
| dc.subject | Booking | en_US |
| dc.subject | Women living with HIV | en_US |
| dc.subject | Uganda | en_US |
| dc.subject | South Africa | en_US |
| dc.title | ‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda | en_US |
| dc.type | Journal Article | en_US |