title: Sociodemographic factors associated with participation by HIV-1-positive pregnant women in an intervention to prevent mother-to-child transmission of HIV in Cote d'Ivoire.
abstract: Many HIV-1-seropositive women in Africa who are offered antiretroviral prophylaxis to prevent mother-to-child transmission (MTCT) of HIV do not begin interventions. Research on barriers to participation has not addressed the possible effects of women's sociocultural and economic circumstances. We examined these factors at an MTCT prevention programme in Abidjan, Cote d'Ivoire. We interviewed two groups of women after they had received HIV-positive test results and had been invited by the programme staff to return for monthly follow-up visits before beginning short-course zidovudine prophylaxis. Participants (n = 30) completed follow-up visits and prophylaxis. Non-participants (n = 27) refused or discontinued follow-up visits and did not begin zidovudine. Fewer non-participants had been born in Cote d'Ivoire (67% vs. 97%) or were Ivorian nationals (48% vs. 77%); they had lived in the country for less time (21 vs. 26 median years). They were less likely to be French-literate (37% vs. 77%), and more of them reported having had Koranic education only (18% vs. 0). They more often reported miscarriages, stillbirths, or infant deaths (69% vs. 33%), and had partners with low-ranked jobs (63% vs. 30%). Our findings suggest that the non-participants were more marginal socioculturally and economically in Ivorian society than participants. Greater attention to mitigating the effects of broader structural factors on women's participation in interventions may increase the effectiveness of MTCT prevention in Africa.
authors.affiliation: Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA 30333, USA. tcp@cdc.gov
authors.forename: T M
authors.initials: TM
authors.lastname: Painter
authors.forename: K L
authors.initials: KL
authors.lastname: Diaby
authors.forename: D M
authors.initials: DM
authors.lastname: Matia
authors.forename: L S
authors.initials: LS
authors.lastname: Lin
authors.forename: T S
authors.initials: TS
authors.lastname: Sibailly
authors.forename: M K
authors.initials: MK
authors.lastname: Kouassims
authors.forename: E R
authors.initials: ER
authors.lastname: Ekpini
authors.forename: T H
authors.initials: TH
authors.lastname: Roels
authors.forename: S Z
authors.initials: SZ
authors.lastname: Wiktor
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007560:Cote d'Ivoire; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission / Q000821:virology; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D012959:Socioeconomic Factors; D015215:Zidovudine / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine