“I just wish that everything is in one place”: facilitators and barriers to continuity of care among HIV-positive, postpartum women with a non-communicable disease in South Africa

ABSTRACT

HIV and non-communicable diseases (NCD) are co-epidemics in South Africa. Comorbid individuals must engage in lifelong care. Postpartum HIV-positive women in South Africa are at high risk of dropping out of HIV care. We explored healthcare utilization among postpartum women requiring chronic management of HIV and NCD. From August – December 2016, we enrolled 25 women in Soweto, South Africa, and conducted one-time interviews. All participants were adult (≥18 years), HIV-positive, postpartum, and diagnosed with a NCD that required further evaluation after delivery. We developed a conceptual model that describes how maternal factors, interaction with environments, and social networks influence follow up engagement. Barriers to follow-up included separate visit days, increased time commitment, transportation and logistics, unfamiliar clinic environments, and disrespectful staff. Factors facilitating patient engagement included social support and partner disclosure. Women were more likely to turn to friends and family for advice regarding HIV or the NCD, rather than a clinic. Women prioritized infant care after delivery, suggesting that baby care may be an entry point for improving maternal care after delivery. Our results support advocating for better integration of services at the primary care level as a method to improve continuity of care for both women and children.

KEYWORDS:

• HIV/AIDS
• South Africa
• pregnancy
• non-communicable diseases (NCD)
• retention in care

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kate Clouse http://orcid.org/0000-0002-0190-7398

David M. Aronoff http://orcid.org/0000-0003-4587-6121

Shane A. Norris http://orcid.org/0000-0001-7124-3788

Additional information

Funding

This work was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number K01MH107256. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the US Government. S.A.N. is supported by the South African Medical Research Council and DST-NRF Centre of Excellence in Human Development at the University of the Witwatersrand, South Africa.