title: Conversations with mothers: exploring reasons for prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa.
abstract: Reasons for incident cases of vertical HIV transmission in the era of free access to PMTCT in South Africa were investigated. This mixed-methods study was conducted in Soweto, South Africa from June-August, 2009. Birthmothers of HIV-infected infants born after 1 December 2008 were eligible. All participants completed an interviewer-administered questionnaire. Women also participated in a focus group (n = 10) or individual structured interview (n = 35). Mean age of participants (n = 45) was 28.7 years (SD = 5.4). Major findings are: (i) failure of per-guideline prescription of ARV strategies for infants (31%) and/or mothers (57%); (ii) maternal refusal of treatment (n = 5); (iii) preterm delivery (31%); (iv) delayed ANC attendance because of facility-related barriers and maternal apprehension around HIV testing; (v) fear of stigma; (vi) maternal difficulty with administering infant AZT (n = 9) and (vii) maternal confusion about infant feeding. A variety of individual, social, and structural factors must be addressed to optimize PMTCT service delivery in South Africa.
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa. laherf@phru.co.za
authors.forename: Fatima
authors.initials: F
authors.lastname: Laher
authors.forename: Angela
authors.initials: A
authors.lastname: Cescon
authors.forename: Erica
authors.initials: E
authors.lastname: Lazarus
authors.forename: Angela
authors.initials: A
authors.lastname: Kaida
authors.forename: Matamela
authors.initials: M
authors.lastname: Makongoza
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Christine N
authors.initials: CN
authors.lastname: Soon
authors.forename: Cari L
authors.initials: CL
authors.lastname: Miller
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008427:Maternal Health Services / Q000458:organization & administration; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011287:Prejudice; D036301:Qualitative Research; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents