title: Breastfeeding: the hidden barrier in Côte d'Ivoire's quest to eliminate mother-to-child transmission of HIV.
abstract: BACKGROUND
  Côte d'Ivoire has one of the worst HIV/AIDS epidemics in West Africa. This study sought to understand how HIV-positive women's life circumstances and interactions with the public health care system in Bouaké, Côte d'Ivoire, influence their self-reported ability to adhere to antiretroviral prophylaxis during pregnancy.
  
  
  METHODS
  Semistructured interviews were conducted with 24 HIV-positive women not eligible for antiretroviral therapy and five health care workers recruited from four public clinics in which prevention of mother-to-child transmission services had been integrated into routine antenatal care.
  
  
  RESULTS
  Self-reported adherence to prophylaxis is high, but women struggle to observe (outdated) guidelines for rapid infant weaning. Women's positive interactions with health providers, their motivation to protect their infants and the availability of free antiretrovirals seem to override most potential barriers to prophylaxis adherence.
  
  
  CONCLUSIONS
  This study reveals the importance of considering the full continuum of prevention of mother-to-child transmission interventions, including infant feeding, instead of focussing primarily on prophylaxis for the mother and newborn.
authors.affiliation: Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA; heather.buesseler@gmail.com.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Buesseler
authors.affiliation: Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA; Health Alliance International, Seattle, WA, USA.
authors.forename: Ahoua
authors.initials: A
authors.lastname: Kone
authors.affiliation: Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA; Health Alliance International, Seattle, WA, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Robinson
authors.affiliation: International Training and Education Center for Health (I-TECH), Seattle, WA, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Bakor
authors.affiliation: Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Senturia
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000523:psychology; D001294:Attitude to Health; D001942:Breast Feeding / Q000009:adverse effects*; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D055118:Medication Adherence / Q000523:psychology; D009042:Motivation; D012650:Self Disclosure; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: ARV; HIV; PMTCT; adherence; breastfeeding; infant feeding; prophylaxis; qualitative
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