Women's reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study

doi:10.1136/bmj.329.7465.543

BMJ 2004;329:543 (4 September), doi:10.1136/bmj.329.7465.543

Paper

Women's reasons for not participating in follow up visits before starting short course antiretroviral prophylaxis for prevention of mother to child transmission of HIV: qualitative interview study

Thomas M Painter, behavioral scientist¹, Kassamba L Diaby, medical supervisor³, Danielle M Matia, program officer², Lillian S Lin, acting leader, statistics team¹, Toussaint S Sibailly, technical advisor⁵, Moïse K Kouassi, manager, local area network³, Ehounou R Ekpini, medical officer⁴, Thierry H Roels, associate director⁶, Stefan Z Wiktor, chief, Surveillance and Infrastructure Development Branch, Global AIDS Program¹

¹ Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail stop E-37, Atlanta, Georgia 30333, USA, ² 266th Pl SE, Sammamish, Washington 98075, USA, ³ Projet RETRO-CI, US Embassy/CDC-HIV, 01 BP 1712 Abidjan 01, Côte d'Ivoire, ⁴ Department of HIV/AIDS (Prevention)-Room C-128, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland, ⁵ Centers for Disease Control and Prevention, Global AIDS Program, Rwanda, US Embassy, BP 28, Kigali, Rwanda, ⁶ Global AIDS Program, BOTUSA Project, PO Box 90, Gaborone, Botswana

Correspondence to: T M Painter tcp2{at}cdc.gov

Objective To find out why pregnant women who receive HIV-1 positivetest results and are offered short course antiretroviral prophylaxisto prevent transmission of HIV from mother to child do not participatein necessary follow up visits before starting prophylaxis.

Design Qualitative interview study.

Setting A programme aiming to prevent transmission of HIV frommother to child at a public antenatal clinic in Abidjan, Côted'Ivoire.

Participants Purposive sample of 27 women who had received HIV-1positive test results and were invited to return for monthlyfollow up visits before starting prophylaxis with zidovudineat 36 weeks' gestation, but who had either refused or discontinuedthe visits. None of the women started prophylaxis.

Results Most of the women explained their non-participationin follow up visits by referring to negative experiences thatthey had had while interacting with programme staff or to theirviews about the programme. Additional reasons concerned theirdisbelief of HIV positive test results and personal factors.

Conclusions Difficulties experienced by women during their contactswith staff working on the prevention programme and negativeviews that they have about the programme can contribute to theirnon-participation in prophylaxis. Training and supervision ofprogramme staff may increase the likelihood of positive interactionsbetween staff and clients, thereby facilitating women's participationin preventing transmission of HIV from mother to child. Outreachand mobilisation in communities that are served by preventionprogrammes may complement these measures at programme levelby contributing to increased social support for women's effortsto prevent transmission of HIV from mother to child.

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