Exploring perceptions and attitudes of users and providers on interventions towards prevention of mother to child transmission of HIV in Soweto, South Africa. (Focus: knowledge and experience).
Date
2014-11
Authors
Pule, Matseliso
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Introduction: After 12 years of implementing the national Prevention of Mother-to-Child
Transmission of HIV (PMTCT) programme in South Africa, interventions to prevent
MTCT of HIV are now offered in more than 95% of public antenatal and maternity
facilities country-wide free of charge (MRC, 2010), even though HIV/AIDS-related
diseases are said to be a major cause of death in young children (UNICEF, 2011). The
context within which women make decisions about PMTCT participation depends on,
amongst other things, the level of their knowledge about HIV/AIDS (Leonard et al, 2001;
Sematimba et al, 2004). The concept of behavior-based programming is central to a
behavior change approach to reducing Mother-to-Child Transmission of HIV. This
places behaviours at the centre of the program design process (Moore, 2003).
Understanding the providers and users of the PMTCT interventions’ knowledge and
experience on HIV and PMTCT is therefore important to ensure appropriate
interventions to address beliefs, attitudes, myths and misunderstandings.
Methodology: Semi-structured interviews were conducted with users of the PMTCT
programme, while structured survey questionnaires were collected with the providers of
the PMTCT programme in early 2012. Users of the PMTCT programme were asked
questions regarding HIV knowledge, experience of HIV testing in pregnancy, PMTCT
knowledge and experience of the PMTCT programme. We also asked questions on
infant feeding choices and practices. Forty six interviews were carried out with
participants at three ANC Clinics with PMTCT services in Soweto - Gauteng. Thirty
were users of PMTCT programme and sixteen were providers of PMTCT service.
Results: All participants understood that HIV was a virus that affected the immune
system. Results show that there is generally a good understanding of HIV and how it is
transmitted. In addition there was a good understanding on methods to prevent
acquiring HIV. There was a general feeling that a lot of people were afraid of being
tested. Interestingly, most participants believed that people who were pregnant or sick
had no choice but to get tested. Most of the participants believed that education should
be a tool used to motivate more people to get tested for HIV. Most users in this study
disclosed their HIV status and PMTCT programme use. Overwhelmingly the decision to
participate was based on the desire not to infect their infants. Women had been
informed that mixed feeding increased the risk of transmission by breast feeding. There
were a few participants who believed that HIV infected women should not breastfed. It
was found that almost two-thirds of the women in this study were formula feeding their
infants. Reason cited for formula feeding was that they did not want to infect their
infants.
As far as PMTCT knowledge was concerned, it was found that almost all health care
providers knew that the most common route of HIV acquisition was through
heterosexual sexual practices. All the HCWs knew that prolonged breastfeeding
increased the risk of transmission. Reassuringly all HCWs knew not to use invasive
delivery procedures and that risk of transmission was decreased with low maternal viral
load. Only 50% of the HCWs indicated that the first choice of WHO- recommended
mother-to-child regimen for antiretroviral prophylaxis in PMTCT was Zidovudine (ZDV)
and Nevirapine (NVP) (WHO, 2012). The HCWs understood that infant formula did not
provide superior nutritional support or antibody protection. They also knew that formula
feeding carried increased risk of diahorrea or bacterial infections. There was confusion
regarding the duration of exclusive breast feeding. Only half of the HCWs stated that
post-natal infant-feeding counselling and follow-up are required whenever a mother
decides to change her feeding practice. HCW participants felt that most patients fail to
adhere to their medication requirements. This was cited to be mainly due to the fact that
patients may not have disclosed their HIV status to the household members. Baby
feeding choices are cited as the strongest barriers to the success of the PMTCT
programmes. Mothers who have not disclosed their HIV status to their household
members find it difficult to comply with the chosen feeding choices especially bottle
feeding; they therefore opt for exclusive breastfeeding –which family members attempt
to interrupt with mixed feeding practices for a number of reasons.
Conclusion: Contrary to studies cited in the literature review, health systems failure
was not a major problem in Soweto and therefore was not a factor that could impact on
either the knowledge or the experience of users and providers. Even though disclosure
rates were high amongst the users interviewed in this study, participants believed that
the biggest barrier to people participating in the PMTCT programme was because of
stigma, ignorance, and fear that they may be recognised while accessing services by
people they may know. Although women had been provided with information on
exclusively breastfeed, most users of the PMTCT programme interviewed were bottlefeeding
– not due to stigma, but due to fear of transmission. In terms of barriers –
adherence was noted as a major problem by providers. This linked to issues of feeding
practices - if mothers bottle-feed they are stigmatised and opt for exclusive feeding, but
are then forced by family to supplement with the bottle for various reasons. Mothers do
not reveal their status, which jeopardises their success on the programme
Description
A research report submitted to the School of Public Health, University of the
Witwatersrand (Johannesburg, South Africa) in partial fulfilment of the requirements for
the degree of Master of Public Health for the year 2014