A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia

By Adedimeji, Adebola; Abboud, Nareen et al. | International Journal of Population Research, January 1, 2012 | Go to article overview

A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia


Adedimeji, Adebola, Abboud, Nareen, Merdekios, Behailu, Shiferaw, Miriam, International Journal of Population Research


Adebola Adedimeji 1 and Nareen Abboud 1 and Behailu Merdekios 2 and Miriam Shiferaw 1

Recommended by Pranitha Maharaj

1, Centre for Public Health Sciences, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York, NY 10461, USA 2, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia

Received 30 March 2012; Revised 23 May 2012; Accepted 11 June 2012

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Background

In 2009, the United Nations AIDS Program (UNAIDS) reported that 430,000 of the approximately 2.5 million children under the age of 15 living with HIV were newly infected, the majority in sub-Saharan Africa [1]. Many of these children acquired the infection from their mothers during pregnancy, birth, or breastfeeding. Timely administration of antiretroviral drugs to a HIV-positive pregnant woman and her newborn child significantly reduces the risk of mother-to-child transmission [2]. Now recognized as an attainable public health strategy, preventing mother-to-child transmission (PMTCT) has four basic components: (i) prevention of primary infection among women, (ii) prevention of unintended pregnancies among HIV positive women, (iii) provision of specific interventions to reduce the risk of mother-to-child transmission, and (iv) provision of care, treatment and support to HIV infected women, their infants and families [3, 4]. Providing highly active antiretroviral therapy to a woman will reduce viral replication and viral load during pregnancy, and as a postexposure prophylaxis, prevent infection in newborns [3, 5, 6].

Interventions to reduce pediatric HIV infection have become readily available worldwide, especially in low and middle-income countries. In 2009, 53% of HIV-infected pregnant women worldwide received antiretroviral (ARV) drugs to prevent mother-to-child transmission [7]. While coverage is increasing in sub-Saharan Africa, ranging from 8% in some settings to 54% in others [3], PMTCT programs in the continent are still plagued by multiple problems. For instance, many HIV positive pregnant women still face constraints in accessing ARV drugs because they refuse to participate or are lost to followup in existing programs. Health system factors (critical shortage of personnel, lack of skilled attendant at birth, poor infrastructure, and inadequate supply of PMTCT kits) as well as individual and socio-cultural factors (stigma, nonawareness of PMTCT services, lack of spousal and family support, loss to followup, negative experiences with hospital staff, the preference for home delivery) have been highlighted as barriers in the literature [8-13].

Ethiopia, like most countries in sub-Saharan Africa, is experiencing a high prevalence of HIV with about 2.1% of the adult population living with the virus [14, 15] largely due to heterosexual transmission. Besides heterosexual transmission, vertical transmission of HIV from mother-to-child accounts for more than 90% of pediatric AIDS [16]. To reduce the number of mother-to-child HIV infections, the government set a goal of universal access and increased the capacity for the delivery of HIV counseling and testing, prevention of mother-to-child transmission, and provision of ARVs by about 2-, 6-, and 8-fold, respectively [15]. Despite this increase, the number of women accessing these services is still low. For instance, after more than 5 years since the goal for universal access was established, less than 7,000 HIV positive pregnant women received ARV prophylaxis, representing about 19% of the annual targets [16]. Similarly, Nigatu and Woldegebriel [17] showed from nationally available data that 47% of known HIV positive pregnant women were not receiving ARVs and 62% of known HIV exposed infants were not receiving ARVs, alarming results that are consistent with findings from other low-income countries [10, 11, 13, 15, 18, 19]. …

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