“I…Tell Her Not to Take Medicines”: Understanding Engagement in the Prevention of Mother to Child Transmission (PMTCT) Care Continuum through the Socio-Ecological Model
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Study Setting
2.3. Participants and Recruitment
2.4. Ethical Clearance
2.5. Study Sample Size and Sampling
2.6. In-Depth Interview Guide for Data Collection
2.7. Data Processing and Analysis
3. Results
3.1. Participant Characteristics
3.2. Qualitative Analysis
3.2.1. Individual
3.2.2. Male Involvement
3.2.3. Support from Peers and Family
3.2.4. Community Context
3.2.5. Sociocultural Factors
3.2.6. Wider Environment Factors
4. Discussion
4.1. Limitations
4.2. Recommendations for Practice and Policy
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | Mother (n = 16) | Mother % | Father (n = 15) | Father % | Total (n = 31) | Total (%) |
---|---|---|---|---|---|---|
Point of HIV Testing of Pregnant Mother | ||||||
Routine ANC testing (mother) | 14 | 87.5 | 12 | 80 | 26 | 83.9 |
Both parents tested together | 5 | 31.6 | 5 | 33.3 | 10 | 32.3 |
Mother tested later due to sickness | 2 | 12.5 | 3 | 20.0 | 5 | 16.2 |
Husband positive before mother | 7 | 43.8 | 6 | 40.0 | 13 | 41.9 |
Education | ||||||
Inability to read and write or no formal education | 4 | 25.0 | 0 | 0 | 4 | 12.9 |
Primary (able to read and write but completed less than 7th standard) | 9 | 56.3 | 7 | 46.7 | 16 | 51.6 |
Secondary (completed 7th standard but less than 12th standard) | 2 | 12.5 | 8 | 53.3 | 10 | 32.3 |
Higher-Secondary (completed 12th standard) or/and above | 1 | 6.2 | 0 | 0 | 1 | 3.2 |
Place of Delivery | ||||||
Government hospital | 13 | 81.3 | 10 | 66.7 | 23 | 74.2 |
Private hospital | 3 | 18.7 | 3 | 20.0 | 6 | 19.4 |
Home | 0 | 0 | 2 | 13.3 | 2 | 6.4 |
Type of Delivery | ||||||
Caesarean section | 9 | 56.3 | 6 | 40.0 | 15 | 48.4 |
Vaginal | 7 | 43.7 | 9 | 60.0 | 16 | 51.6 |
Nevirapine (NVP) Prophylaxis Administered to New-born | ||||||
Yes | 15 | 93.8 | 10 | 66.7 | 25 | 80.6 |
No | 1 | 6.2 | 5 | 33.3 | 6 | 19.4 |
Themes | Facilitators | Barriers |
---|---|---|
Intrapersonal and Interpersonal Socio-economic Factors | ||
Individual | Routine antenatal HIV testing Hope for a new baby Knowledge about medical care available | Feeling of anxiety Poor awareness about PMTCT Feeling betrayed by partner (husband positive before wife) |
Interpersonal/Male involvement | HIV-positive status of men Men’s awareness about PMTCT and ART | Negative father and positive mother Mother tested positive during routine ANC testing (before father) |
Peer and family influences | Educational status of family members Awareness about available health and support facilities | Fear of disclosure and repercussions Poor awareness about HIV prevention, care and support program |
Community and socio-cultural context | Social network of positive people Outreach (Community) workers Public health services Perceived good quality care | HIV-associated stigma Distance to travel Village/rural settings Expectations of breastfeeding baby Private healthcare providers enforced internalised (self) stigma |
Wider Environment Factors | ||
Health system and infrastructure | Caring attitude and information provided by healthcare provider Linking of PPMCT and ART centre Counselling of partners and family members by trained staff | Separate mother and child health-care departments Private hospitals testing and treatment policies Referral to other setups |
Health Policies | Early infant diagnosis tool (EID) Growth monitoring Periodic check-ups of mother and baby Antiretroviral prophylaxis for HIV exposed baby | Unavailability of resources in public healthcare sector Non-uniform and unregulated implementation of PPTCT program by private medical sector |
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Modi, A.; Garcia-Alcaraz, C.; Trivedi, S.; Kosambiya, J.K.; Wells, K.J. “I…Tell Her Not to Take Medicines”: Understanding Engagement in the Prevention of Mother to Child Transmission (PMTCT) Care Continuum through the Socio-Ecological Model. Int. J. Environ. Res. Public Health 2022, 19, 13530. https://doi.org/10.3390/ijerph192013530
Modi A, Garcia-Alcaraz C, Trivedi S, Kosambiya JK, Wells KJ. “I…Tell Her Not to Take Medicines”: Understanding Engagement in the Prevention of Mother to Child Transmission (PMTCT) Care Continuum through the Socio-Ecological Model. International Journal of Environmental Research and Public Health. 2022; 19(20):13530. https://doi.org/10.3390/ijerph192013530
Chicago/Turabian StyleModi, Anjali, Cristian Garcia-Alcaraz, Sangita Trivedi, J. K. Kosambiya, and Kristen J. Wells. 2022. "“I…Tell Her Not to Take Medicines”: Understanding Engagement in the Prevention of Mother to Child Transmission (PMTCT) Care Continuum through the Socio-Ecological Model" International Journal of Environmental Research and Public Health 19, no. 20: 13530. https://doi.org/10.3390/ijerph192013530