E-drug: BMJ: Women and HIV follow-up visits
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BMJ 2004;329:543 (4 September), doi:10.1136/bmj.329.7465.543
http://bmj.bmjjournals.com/cgi/content/abstract/329/7465/543
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,
Mo�se 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, C�te 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@cdc.gov
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, C�te 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.
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