Health Alliance International

Stories from the Field: PMTCT Loss to Follow-Up

Posted: Dec 19, 2009 · Posted by: Beatriz Thomé, Research Assistant

My name is Beatriz Thomé. I'm originally from Brazil, trained as a pediatrician and I am now finishing up my Master in Public Health degree from the Global Health Department at the University of Washington. I have been a research assistant with Health Alliance International since 2008. For the past six months, I have been living in Mozambique and working with HAI and the Ministry of Health on preventing HIV transmission from mothers to babies.

Mozambique, like other sub-Saharan settings, has high rates of loss-to-follow-up for both mothers and infants in their National Program of Prevention of Mother to Child HIV Transmission (PMTCT). This prevents women from receiving timely HIV treatment (highly active antiretroviral therapy, or HAART) or prevention ARV drugs, as well as deprives them from receiving other preventiive care that could protect them and their babies.

I am conducting an explorative qualitative study in order to better understand the reasons for the loss-to-follow-up encountered by the Ministry of Health in PMTCT Programs.  The main purpose of this exploratory study is to document HIV-positive pregnant women's experiences and perceptions regarding their health-seeking behavior and factors that contribute to high rates of loss-to-follow-up.

Through the study, I hope to describe women's own preferences, desires, intentions, perceptions and experiences, and also learn more about the community responses to universal HIV screening in prenatal care clinics, stigma and support networks for pregnant women.

Since last August I have been working in two health centers that offer prenatal care as well as HIV care in the Province of Sofala and their surrounding neighborhoods.

So far, in my individual interviews I have found that women's testimonies have been quite varied, but in general the women talk little in terms of barriers to follow-up but when they do it is often stigma related--for instance, about the difficulties in sharing the diagnosis at home, especially with their husbands.

In the communities served by the two health centers participating in the study, we have been conducting individual interviews of women of child-bearing age, and focus group discussions with both men and women. We witness how people talk more freely, especially in groups. Themes such as the disruption of the family because of the disclosure of HIV status, lack of confidence in health care systems--starting from the HIV test result itself to the drugs (ARVs) used for treatment, the collision between traditional medicine, rituals and beliefs and the services being offered at the health centers, are common.

I believe that the more capable we are of understanding women's and families' universes and the factors that both inhibit or help women's access, the better we will be at supporting them and advocating for more comprehensive services to HIV-positive women.

The team (from left to right): Beatriz with research assistants Lucia Lazaro and Javelina Aguiar