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"At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania.
PLoS One. 2020; 15(8):e0238232.Plos

Abstract

INTRODUCTION

Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services.

METHODS

We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis.

RESULTS

We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement.

CONCLUSION

In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.

Authors+Show Affiliations

Kilimanjaro Clinical Research Institute, Moshi, Tanzania. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.Kilimanjaro Christian Medical University College, Moshi, Tanzania.Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.Kilimanjaro Clinical Research Institute, Moshi, Tanzania. The University of Cape Town, Cape Town, South Africa.Kilimanjaro Clinical Research Institute, Moshi, Tanzania. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America. Kilimanjaro Christian Medical University College, Moshi, Tanzania. Kilimanjaro Christian Medical Centre, Moshi, Tanzania.Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

32853233

Citation

Kisigo, Godfrey A., et al. ""At Home, No One Knows": a Qualitative Study of Retention Challenges Among Women Living With HIV in Tanzania." PloS One, vol. 15, no. 8, 2020, pp. e0238232.
Kisigo GA, Ngocho JS, Knettel BA, et al. "At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania. PLoS One. 2020;15(8):e0238232.
Kisigo, G. A., Ngocho, J. S., Knettel, B. A., Oshosen, M., Mmbaga, B. T., & Watt, M. H. (2020). "At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania. PloS One, 15(8), e0238232. https://doi.org/10.1371/journal.pone.0238232
Kisigo GA, et al. "At Home, No One Knows": a Qualitative Study of Retention Challenges Among Women Living With HIV in Tanzania. PLoS One. 2020;15(8):e0238232. PubMed PMID: 32853233.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "At home, no one knows": A qualitative study of retention challenges among women living with HIV in Tanzania. AU - Kisigo,Godfrey A, AU - Ngocho,James S, AU - Knettel,Brandon A, AU - Oshosen,Martha, AU - Mmbaga,Blandina T, AU - Watt,Melissa H, Y1 - 2020/08/27/ PY - 2019/12/20/received PY - 2020/08/12/accepted PY - 2020/8/28/entrez PY - 2020/8/28/pubmed PY - 2020/10/21/medline SP - e0238232 EP - e0238232 JF - PloS one JO - PLoS One VL - 15 IS - 8 N2 - INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32853233/"At_home_no_one_knows":_A_qualitative_study_of_retention_challenges_among_women_living_with_HIV_in_Tanzania_ L2 - https://dx.plos.org/10.1371/journal.pone.0238232 DB - PRIME DP - Unbound Medicine ER -