Exploring loss to follow-up among women living with HIV in Prevention of Mother to Child Transmission programmes in Côte d'Ivoire

Abstract

The expansion of Prevention of Mother to Child Transmission (PMTCT) services globally has been accompanied by significant rates of loss to follow-up (LTFU). This study explored barriers and facilitators to participation in PMTCT programmes for pregnant and post-partum women living with HIV who had been LTFU at public sector antenatal care facilities in the Vallée du Bandama region of Côte d'Ivoire, West Africa. Three types of interviews were conducted at seven health sites: (1) individual or small group interviews with health staff; (2) one focus group with women actively enrolled in PMTCT services; and (3) individual interviews with women who had been LTFU from PMTCT services. Ten main themes emerged and were classified within a modified social ecological model. The individual level barriers included discouragement and internalised stigma, while hope for self/child's health was a facilitator. The family/community level barriers were fear of stigma and gender inequities. The health system level barriers were unclear information and poor post-test counselling, while staff advice and support groups were facilitators. The structural level barrier was associated costs. Factors on all four levels of the social ecological model must be addressed in order to maximise adherence to PMTCT services.

Keywords:

• PMTCT
• Côte d'Ivoire
• LTFU
• HIV/AIDS
• West Africa

Acknowledgements

The authors thank the staff of Health Alliance International-Côte d’Ivoire, specifically Bamba Atta and Aimé Serge Dali, and the staff of the Côte d’Ivoire Ministère de la Santé et de l’Hygiène Publique. We recognise David Grembowski, the staff of the Department of Health Services and the staff of the Department of Global Health at the University of Washington for their support. Most importantly we are indebted to the Ivoirian women who opened their hearts and shared their stories. May we have done justice to the privilege of relaying their voice.