Barriers to antiretroviral therapy (ART) initiation for treatment-eligible HIV-positive pregnant women in Swaziland
Background: Swaziland has one of the highest HIV
prevalence rates in the world, with 41% of pregnant women living with HIV. Antiretroviral
therapy (ART) is available for all treatment-eligible pregnant women, yet some
women choose not to initiate. The Elizabeth Glaser Pediatric AIDS Foundation
(EGPAF)-Swaziland program conducted a qualitative study exploring factors
associated with lack of ART initiation among HIV-positive, treatment-eligible pregnant
women in Swaziland. Data were collected July-September
2011.
Methods: Though
convenience sampling, EGPAF recruited HIV-positive, treatment-eligible,
postpartum women and health care workers (HCWs) within maternal and child
health (MCH) units; participants came from both urban and rural areas. Focus
group discussions (FGDs) and in-depth interviews were conducted to gain an
understanding of what influences a pregnant women's decision to initiate ART. Seven
FGDs (of 5-11 participants) were conducted by EGPAF staff, four with HCWs, two
with clients that chose to initiate ART, and one with clients who chose not to
initiate ART (n=59). A total of 83 interviews
were conducted by EGPAF-trained nurses; 50 with women who did initiate and 33
with women who did not initiate. Audio
from the FGD and interviews was recorded and transcribed. Data were analyzed
using Maxqda software.
Results: Four themes emerged regarding barriers to
ART initiation: stigma and disclosure, facility challenges, lack of ART
knowledge, and anxiety around a lifelong commitment to ART. Participants
reported fear of disclosure to partners and lack of knowledge on how to
disclose. Facility issues included lack of privacy and difficulties receiving
CD4 test results. Lack of ART knowledge, including fear of side effects from
medicines was a significant concern of the patients (not HCWs). Concerns around
non-adherence, developing resistance, or not being able to access drugs were
the main factors related to fear of lifelong ART. Suggested solutions included
improved privacy for ART collection, access to rapid CD4 testing, community-level
education about HIV and ART, and stronger disclosure counseling and support
groups.
Conclusion: This study revealed
several barriers to acceptance of ART among eligible pregnant women that will
be critical to address, particularly as WHO ART guidelines move towards
lifelong ART for all HIV-positive women.
K. Kudiabor1, L. Katirayi2, C. Chouraya1, B. Nhlabatsi3, M. Mahdi1
1Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Swaziland, 2Elizabeth Glaser Pediatric AIDS Foundation, Washington, United States, 3Swaziland Minstry of Health, Mbabane, Swaziland