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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: https://doi.org/10.1136/bmj.329.7465.543 (Published 02 September 2004) Cite this as: BMJ 2004;329:543

Uptake of HIV Prophylaxis

[Re:] Painter, T.M. et al, 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, British Medical Journal, 329 4 Sep 2004 (electronic)

I read with interest the paper by Painter, T.M. et al1, and I believe
that the importance of prevention of diseases cannot be more emphasized,
although the achievement of modern medicine in terms of treatment and cure
is prominent. The study result of this article again reminded us how
important the public education is to reduce prevalence of diseases, though
there were other factors that contribute the avoidance of follow-up by
women with HIV-1 positive test, such as accessibility, cost, tolerability,
peer experience, and cultural differences.

Preventative strategies against incurable diseases, of which the
incidence can be declined by controlling the possible risk factors, have
yielded a significantly positive effect to reduce the incidence. AIDS, for
example, is believed to be transmitted as a sexually transmitted disease;
through needle sharing; and as a perinatal infection. Safe sex, using
disposable, clean needle and antenatal prophylaxis therefore, have proven
to reduce the risk of infection. According to the study conducted by Duong
et al, the risk of vertical transmission of HIV was markedly reduced from
31.6% to 4.2% when antenatal prophylactic antiretroviral therapy was given
to the pregnant women carrying HIV.2

More than 1500 children a day acquire HIV-1 infection from their
mother in Africa, of which up to 60% children die within two years after
birth.2 Therefore, in my opinion, it would be ideal if all HIV carriers
undergo proper education about safety issue and antenatal prophylactic
antiretroviral therapy to minimize the chance of vertical transmission.
Misconception of HIV transmission and acquisition as well as incomplete
knowledge of prophylactic treatment, however, seem to be prevalent among
new mothers with HIV positive result, not only in Africa but also in other
developed countries. That is, only 11% and 56% of women completely
understood the prophylactic program in Africa and four states of USA
respectively. 1,4

Although this did not appear to affect the rate of prenatal test,4
there is no point to proceed such screening test if the candidates would
not initiate or continue the prophylactic therapy. Public health efforts,
therefore, should be made to educate the mother-to-be about methods of
preventing vertical transmission of HIV by providing them sufficient
information; and to explain clear instruction of the therapy. It is one
recommended method to provide them a survey questionnaire to ensure their
level of understanding. Finally, health care professionals and all staffs
working at such institution should respect and consider their patients as
much as possible to enhance the patients’ trust in the public health
system. It will be helpful to increase patients’ compliance and cost-
effectiveness in terms of public health.

From:
Ciel Heo
4th year medical student, Macarthur Ambulatory Care Service
Campbelltown, NSW 2560, Australia

Reference:

1. Painter, T.M. et al, 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, British Medical Journal, 329 4 Sep 2004 (electronic)

2. Duong T et al. Vertical transmission rates for HIV in the British
Isles: estimates based on surveillance data. British Medical Journal
319:1227-1229, 1999.

3. Dabis, F. and Ekpini, E.R., HIV-1/AIDS and maternal and child health in
Africa, Lancet, 259 (9323), 15 June 2002: pp 2097-2104

4. Walter, E.B. et al, New mothers’ knowledge and attitudes about
perinatal human immunodeficiency virus infection, Obstetrics &
Gynecology, 97 (1), Jan 2001: pp 70-76

Competing interests:
None declared

Competing interests: No competing interests

29 September 2004
Ciel Heo
Medical Student
Macarthur Health Service