title: "What they wanted was to give birth; nothing else": barriers to retention in option B+ HIV care among postpartum women in South Africa.
abstract: BACKGROUND
  Women initiating antiretroviral therapy during pregnancy have high rates of dropout, particularly after delivery. We aimed to identify challenges to postpartum retention in care under Option B+, which expands antiretroviral therapy access to all HIV-positive pregnant women regardless of CD4 count.
  
  
  METHODS
  We performed 2 semi-structured interviews (SSI, n = 50) and 1 focus group discussion (n = 8) with HIV-positive women at Witkoppen Health and Welfare Centre, a primary care facility in Johannesburg, South Africa, that is one of the only clinics offering Option B+ in South Africa.
  
  
  RESULTS
  Fifty women completed the SSI before delivery, and 48 (96%) completed the second SSI within 3 months of delivery. Median age was 28 years (interquartile range: 26-34); most women worked (62%) or had worked in the previous year (18%). Postpartum women attending HIV care perceived that barriers to HIV care after delivery among other women included the belief that mothers care more about the baby's health than their own (29.2%, 14/48), women were "ignorant" or "irresponsible" (16.7%, 8/48), negative clinic staff treatment (12.5%, 6/48), and denial or lack of disclosure of HIV status (10.4% each, 5/48). Experienced barriers included lack of money (18.0%, 9/50), work conflict (6.0%, 3/50), and negative staff treatment (6.0%, 3/50). During the focus group discussion, 3 main themes emerged: conflict with work commitment, negative treatment from health-care workers, and lack of disclosure related to stigma.
  
  
  CONCLUSIONS
  We identified a complex set of interconnected barriers to retaining postpartum women in HIV care under Option B+, including structural, personal, and societal barriers. The importance of postpartum HIV care for the mother's own health must be embraced by health-care workers and public health programs.
authors: *Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; †Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC; and ‡Witkoppen Health and Welfare Centre, Johannesburg, South Africa.
authors: Kate
authors: K
authors: Clouse
authors: Sheree
authors: S
authors: Schwartz
authors: Annelies
authors: A
authors: Van Rie
authors: Jean
authors: J
authors: Bassett
authors: Nompumelelo
authors: N
authors: Yende
authors: Audrey
authors: A
authors: Pettifor
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010865:Pilot Projects; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000523:psychology / Q000821:virology*; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents