title: Factors influencing utilization of postpartum CD4 count testing by HIV-positive women not yet eligible for antiretroviral treatment.
abstract: Delayed antiretroviral initiation is associated with increased mortality, but individuals frequently delay seeking treatment. To increase early antiretroviral therapy (ART) enrollment of HIV-positive women, antenatal clinics are implementing regular, postpartum CD4 count testing. We examined factors influencing women's utilization of extended CD4 count testing. About 53 in-depth interviews were conducted with nurses, patients, social support persons, and government health officials at three antenatal clinics in Lilongwe, Malawi. Counseling and positive interactions with staff emerged as facilitating factors. Women wanted to know their CD4 count, but didn't understand the importance of early ART initiation. Support from husbands facilitated women's return to the clinic. Reminders were perceived as helpful but ineffectively employed. Staff identified lack of communication, difficulty in tracking, and referring women as barriers. Counseling messages should emphasize the importance of starting ART early. Clinics should focus on male partner involvement, case management, staff communication, and appointment reminders. Follow-up should be offered at multiple service points.
authors.affiliation: Family Health International, Science Facilitation, USA. kate.gilles@gmail.com
authors.forename: Kate P
authors.initials: KP
authors.lastname: Gilles
authors.forename: Chifundo
authors.initials: C
authors.lastname: Zimba
authors.forename: Innocent
authors.initials: I
authors.lastname: Mofolo
authors.forename: Emily
authors.initials: E
authors.lastname: Bobrow
authors.forename: Gloria
authors.initials: G
authors.lastname: Hamela
authors.forename: Francis
authors.initials: F
authors.lastname: Martinson
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data*; D003376:Counseling; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008295:Malawi; D010353:Patient Education as Topic; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D018454:Spouses; D013997:Time Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents