title: Patient and provider perspectives on improving the linkage of HIV-positive pregnant women to long-term HIV care and treatment in eastern Uganda.
abstract: Despite strong evidence that antiretroviral therapy (ART) reduces the risk of mother-to-child transmission of HIV and improves the health of HIV-positive mothers, many HIV-positive pregnant women do not enrol into long-term HIV care and treatment. This study examined barriers and facilitators to the linkage of HIV-positive pregnant women from antenatal care (ANC) to long-term HIV care from patient and provider perspectives, following the implementation of a collaborative quality improvement project in Eastern Uganda. It also solicited recommendations for improving linkages to HIV care. Structured interviews were conducted with 11 health providers and 48 HIV-positive mothers enrolled in HIV care. Facilitators to linking HIV-positive pregnant women to long-term HIV care identified included support from expert clients, escorted referrals, same-day HIV care registration, and coordination between ANC and HIV services. Barriers reported included shortages in HIV testing kits and fear of social, physical and medical consequences. Participants recommended integration of ANC and HIV services, reduction in waiting times, HIV counselling by expert clients, and community-based approaches for improving linkages to HIV care. Linking HIV-positive pregnant women to HIV care can be improved through deliberate implementation of quality improvement interventions in facilities to address barriers to access and provide stronger support and community mobilisation.
authors.affiliation: a Department of International Health , Johns Hopkins Bloomberg School of Public Health , 615 North Wolfe Street, Baltimore , Maryland 21205-2103 , USA.
authors.forename: Haneefa
authors.initials: H
authors.lastname: Saleem
authors.forename: Robert
authors.initials: R
authors.lastname: Kyeyagalire
authors.forename: Sarah Smith
authors.initials: SS
authors.lastname: Lunsford
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003376:Counseling; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D008134:Long-Term Care / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014454:Uganda; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: antenatal care; linkage to care; long-term HIV care and treatment; quality improvement