Barriers associated with the utilization of continued care among HIV-infected women who had previously enrolled in a private sector PMTCT program in Maharashtra, India

Abstract

Prevention of mother-to-child transmission (PMTCT) programs are considered as an entry point to continued care because they provide an opportunity to link an HIV-infected woman, her partner, and child(ren) (if infected) to long-term treatment and care. However, little is known about the factors associated with the utilization of continued care among women who have previously accessed PMTCT services. Better knowledge of the barriers to continued care in HIV-infected women could lead to effective strategies to increase the uptake of post-PMTCT care. This study was designed to examine the factors associated with the utilization of continued care among HIV-infected women enrolled in the PRAYAS PMTCT program in Maharashtra, India, between 2002 and 2011. All consenting women who had completed the receipt of PMTCT services or who were lost to follow-up at least six months prior to the time of data collection were interviewed. Univariate and multivariate analyses were conducted to estimate the associations between not utilizing continued care and hypothesized risk factors using generalized linear models. Of the 688 eligible HIV-positive women, 311 completed a structured interview. Since their exit from the PMTCT program, 59 (19%) had never utilized HIV-related care, 58 (19%) had intermittently utilized HIV-related care, and 194 (62%) had consistently utilized HIV-related care at regular intervals. After adjusting for potential confounders, women with poor HIV-related knowledge (relative risk [RR] = 1.83; 95% CI: 1.15–2.92), women whose partners had never utilized HIV-related care (RR = 4.82; 95% CI: 2.57–9.04), and women who could not afford to travel to the HIV-care facility (RR = 2.36; 95% CI: 1.23–4.53) were less likely to utilize HIV-related care after exiting the PMTCT program. This study highlights the need for enhanced techniques to impart HIV and antiretroviral therapy-related knowledge and underlines the need for improved partner involvement and financial support for travel to HIV facility to increase the uptake of post-PMTCT treatment and care.

Keywords:

• PMTCT
• India
• HIV
• loss to follow-up
• health care utilization

Acknowledgments

We would like to thank the interviewers Prajakta Mahamuni and Aparna Kulkarni. We would also like to express our deepest gratitude to the entire staff of the PRAYAS PMTCT project as well as the doctors, nurses, and staff of the participating hospitals for being generous with their time and for providing premises to conduct the interviews for this study.