title: Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya.
abstract: BACKGROUND
  As prevention of mother-to-child transmission of HIV (PMTCT) programs and HIV treatment programs rapidly expand in parallel, it is important to determine factors that influence the transition of HIV-infected women from maternal to continuing care.
  
  
  METHODS
  This study aimed to determine rates and co-factors of accessing HIV care by HIV-infected women exiting maternal care. A cross-sectional survey of women who had participated in a PMTCT research study and were referred to care programs in Nairobi, Kenya was conducted.
  
  
  METHODS
  A median of 17 months following referral, women were located by peer counselors and interviewed to determine whether they accessed HIV care and what influenced their care decisions. Fisher's exact test was used to assess the association between client characteristics and access to care.
  
  
  RESULTS
  Peer counselors traced 195 (82%) residences, where they located 116 (59%) participants who provided information on care. Since exit, 50% of participants had changed residence, and 74% reported going to the referral HIV program. Reasons for not accessing care included lack of money, confidentiality, and dislike of the facility. Women who did not access care were less likely to have informed their partner of the referral (p=0.001), and were less likely believe that highly active antiretroviral therapy (HAART) is effective (p<0.01). Among those who accessed care, 33% subsequently discontinued care, most because they did not qualify for HAART. Factors cited as barriers to access included stigma, denial, poor services, and lack of money. Factors that were cited as making care attractive included health education, counseling, free services, and compassion.
  
  
  CONCLUSIONS
  A substantial number of women exiting maternal care do not transit to HIV care programs. Partner involvement, a standardized referral process and more comprehensive HIV education for mothers diagnosed with HIV during pregnancy may facilitate successful transitions between PMTCT and HIV care programs.
authors.affiliation: Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Phelgona A
authors.initials: PA
authors.lastname: Otieno
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Kohler
authors.forename: Rose K
authors.initials: RK
authors.lastname: Bosire
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Brown
authors.forename: Steven W
authors.initials: SW
authors.lastname: Macharia
authors.forename: Grace C
authors.initials: GC
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008427:Maternal Health Services; D009035:Mothers / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D055815:Young Adult
references.citation: N Engl J Med. 2009 Apr 30;360(18):1815-26
references.pmid: 19339714
references.citation: Lancet. 2008 Mar 1;371(9614):752-9
references.pmid: 18313504
references.citation: Curationis. 2007 Jun;30(2):12-23
references.pmid: 17703819
references.citation: Trop Med Int Health. 2005 Dec;10(12):1242-50
references.pmid: 16359404
references.citation: Arch Gynecol Obstet. 2009 Nov;280(5):745-52
references.pmid: 19242706
references.citation: Lancet. 2002 Jul 13;360(9327):119-29
references.pmid: 12126821
references.citation: J Acquir Immune Defic Syndr. 2008 Apr 1;47(4):500-5
references.pmid: 18197117
references.citation: AIDS. 2003 Jan 3;17(1):65-71
references.pmid: 12478070
references.citation: J Acquir Immune Defic Syndr. 2004 Jan 1;35(1):75-81
references.pmid: 14707796
references.citation: J Infect Dis. 2007 Jan 15;195(2):220-9
references.pmid: 17191167
references.citation: JAMA. 2001 Nov 28;286(20):2568-77
references.pmid: 11722271
references.citation: Trans R Soc Trop Med Hyg. 2008 Nov;102(11):1067-74
references.pmid: 18565559
references.citation: AIDS. 2005 Jul 1;19(10):1035-42
references.pmid: 15958834
references.citation: AIDS Care. 2007 Apr;19(4):487-91
references.pmid: 17453588