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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

BMJ 2004; 329 doi: (Published 02 September 2004) Cite this as: BMJ 2004;329:543
  1. Thomas M Painter, behavioral scientist (tcp2{at},
  2. Kassamba L Diaby, medical supervisor3,
  3. Danielle M Matia, program officer2,
  4. Lillian S Lin, acting leader, statistics team1,
  5. Toussaint S Sibailly, technical advisor5,
  6. Moïse K Kouassi, manager, local area network3,
  7. Ehounou R Ekpini, medical officer4,
  8. Thierry H Roels, associate director6,
  9. Stefan Z Wiktor, chief, Surveillance and Infrastructure Development Branch, Global AIDS Program1
  1. 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. 2 266th Pl SE, Sammamish, Washington 98075, USA
  3. 3 Projet RETRO-CI, US Embassy/CDC-HIV, 01 BP 1712 Abidjan 01, Côte d'Ivoire
  4. 4 Department of HIV/AIDS (Prevention)-Room C-128, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
  5. 5 Centers for Disease Control and Prevention, Global AIDS Program, Rwanda, US Embassy, BP 28, Kigali, Rwanda
  6. 6 Global AIDS Program, BOTUSA Project, PO Box 90, Gaborone, Botswana
  1. Correspondence to: T M Painter
  • Accepted 6 July 2004


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

Design Qualitative interview study.

Setting A programme aiming to prevent transmission of HIV from mother to child at a public antenatal clinic in Abidjan, Côte d'Ivoire.

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

Results Most of the women explained their non-participation in follow up visits by referring to negative experiences that they had had while interacting with programme staff or to their views about the programme. Additional reasons concerned their disbelief of HIV positive test results and personal factors.

Conclusions Difficulties experienced by women during their contacts with staff working on the prevention programme and negative views that they have about the programme can contribute to their non-participation in prophylaxis. Training and supervision of programme staff may increase the likelihood of positive interactions between staff and clients, thereby facilitating women's participation in preventing transmission of HIV from mother to child. Outreach and mobilisation in communities that are served by prevention programmes may complement these measures at programme level by contributing to increased social support for women's efforts to prevent transmission of HIV from mother to child.


  • We thank, in Abidjan, the women who were interviewed; our interviewers, Aubin Agnissan, Fatoumata Tirera, and Rosine Touré; and the following staff members of Projet RETRO-CI who helped: Kojo Aboagye, Marie Kofi Kouadjo Adjo, Agnès Adom, Aline Assoma, Adiza Bâ, Edith F. Boni-Ouattara, Kady Dao, Kady Dioumandé-Bamba, Mabel Enti, Anne-Marie Kabran-Assavo, Yvonne Kamelan-Tano, Bénédicta Kouadio, Steven Kpaka, Nathalie Krou-Danho, Safiatou Lingani, Aboua Lucien, Bondo Monga, Delphine Chia N'guessan, Déborah N'Guessan-Yao, Jean Louis N'Jampo, Patricia Patindé, Albert Seri Sekou, Odette Tossou, Leo Weakland, Christiane Wondji Gozo. At the US Centers for Disease Control and Prevention, we thank Eliane Dogoré for help with coding; David Fluker, Eleanor McLellan, and Robert Strotman for software support; and Thomas Peterman, Marc Bulterys, Richard Jenkins, R J Simonds, and Monica Nolan for commenting on earlier versions of the manuscript. We also thank two BMJ reviewers for their useful comments and suggestions. This study was presented in part at the XIIth International Conference on AIDS and STDs in Africa, Ouagadougou, Burkina Faso, December 9-13, 2001 [abstract 10BT2-6].

  • Contributors TMP, KLD, LSL, TSS, MKK, ERE, THR, and SZW designed the study. TMP, KLD, and TSS supervised data collection. MKK developed specialised strategies for data entry. TMP and DMM analysed interview responses. TMP wrote the paper with input from the coauthors and is the guarantor.

  • Funding The research project was funded by the Centers for Disease Control and Prevention (CDC). All of the authors were employed directly or indirectly by the CDC during the design, collection and analysis of data, and write-up of findings.

  • Competing interests None declared.

  • Ethical approval Ethics committee of Côte d'Ivoire's Ministry of Public Health and the Institutional Review Board of the US Centers for Disease Control and Prevention.

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