Factors Associated with Low Early Uptake of a National Program to Prevent Mother to Child Transmission of HIV (PMTCT): Results of a Survey of Mothers and Providers, Botswana, 2003

• Published in: AIDS and behavior 2009-04, Vol.13 (2), p.356-364
• Main Authors: Creek, Tracy, Ntumy, Raphael, Mazhani, Loeto, Moore, Janet, Smith, Monica, Han, George, Shaffer, Nathan, Kilmarx, Peter H.
• Format: Article
• Language: English
• Subjects: Acquired Immune Deficiency Syndrome; Adolescent; Adult; AIDS; Antiretroviral agents; Botswana; Botswana - epidemiology; Clinics; Counseling; Data Collection; Disease transmission; Female; Health Care Services; Health Personnel; Health Psychology; Health Services Accessibility; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; Hospitals; Human immunodeficiency virus; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical - prevention & control; Infectious Diseases; Knowledge; Medical tests; Medications; Medicine; Medicine & Public Health; Midwifery; Mothers; Mothers - statistics & numerical data; Multivariate analysis; National Health Programs - statistics & numerical data; Original Paper; Patient Acceptance of Health Care; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - prevention & control; Prenatal Care; Prevention; Program Evaluation; Public Health; Stigma; Urban areas; Young Adult
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-007-9322-8

In Francistown, Botswana, approximately 40% of pregnant women are HIV positive. PMTCT has been available since 1999, antiretroviral (ARV) therapy since 2001, and 95% of women have antenatal care (ANC) and deliver in hospital. However, in 2002, only 33% of ANC clients were tested for HIV, and not all women with HIV received services. In 2003, we conducted a survey of 504 pregnant and postpartum women to explore reasons for poor program uptake, and interviewed 82 health providers about PMTCT. Most women (95%) believed that all pregnant women should be tested for HIV. In multivariate analysis, factors associated with having an HIV test included being interviewed at an urban site, having a high PMTCT knowledge score, knowing someone receiving PMTCT or ARV therapy, and having a partner who had been tested for HIV. Neither fear of stigma nor resistance from partners were frequent reasons for refusing an HIV test. Providers of HIV services reported discomfort with their knowledge and skills, and 84% believed HIV testing should be routine. Ensuring adequate knowledge about HIV and PMTCT, creating systems whereby HIV-positive women receiving care can educate and support other women, and making HIV testing routine for pregnant women may improve the uptake of HIV testing.