Challenges and commonly used countermeasures in the implementation of lifelong antiretroviral therapy for PMTCT in Central Uganda: Health providers' perspective

• Published in: PloS one Vol. 18; no. 1; p. e0280893
• Main Authors: Mukose, Aggrey David, Bastiaens, Hilde, Makumbi, Fredrick, Buregyeya, Esther, Naigino, Rose, Musinguzi, Joshua, Van Geertruyden, Jean-Pierre, Wanyenze, Rhoda K
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.01.2023; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Biology and Life Sciences; Breast feeding; Breastfeeding & lactation; Care and treatment; Catchment areas; Commodities; Data collection; Disease transmission; Distribution; Dosage and administration; Drug therapy; Fear; Female; Health aspects; Health care facilities; Health facilities; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV infection; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infant; Infectious Disease Transmission, Vertical - prevention & control; Interviews; Male; Maternal-fetal exchange; Medicine and Health Sciences; Occupational training; Patient compliance; People and Places; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - prevention & control; Pregnant women; Prevention; Public health; Qualitative Research; Retention; Risk factors; Side effects; Therapy; Training; Uganda; Womens health; Uganda; Malawi; Sub-Saharan Africa; Ethiopia
• DOI: 10.1371/journal.pone.0280893
• ISSN: 1932-6203

Uganda has implemented lifelong antiretroviral therapy for the prevention of mother-to-child HIV transmission since September 2012. Implementation of this strategy has been met with health provider and client challenges which have persisted up to date. This study explored providers' perspectives on the challenges and countermeasures of the implementation and scale-up of lifelong ART among pregnant and breastfeeding women. A qualitative descriptive study was conducted whereby 54 purposively selected participants from six facilities in three districts of Central Uganda namely; Masaka, Mityana, and Luwero were recruited. A key informant interview guide was used to collect data from the study participants. The data were thematically analysed using Atlas-ti, Version 7. Study participants reported challenges under the themes of 1) inadequacy of HIV service delivery (lack of relevant training, health provider shortages, inadequate counselling, stock-outs of essential HIV commodities); 2) Non-utilization of HIV services (Non-disclosure of HIV- positive results, denial of HIV positive results, fear to be followed up, unwillingness to be referred, large catchment area, lack of transport); and 3) Suboptimal treatment adherence (fear of ART side effects, preference for traditional medicines, low male partner involvement in care and treatment). Strategies such as on-job training, mentorship, task shifting, redistribution of HIV commodities across facilities, accompanying of women to mother-baby care points, ongoing counseling of women, peers, and family support groups were commonly used countermeasures. This study highlights key challenges that health providers face in implementing lifelong antiretroviral therapy services among pregnant and postpartum women. Context-specific, innovative, and multilevel system interventions are required at national, district, health facility, community and individual levels to scale up and sustain the lifelong antiretroviral therapy strategy among pregnant and breastfeeding women.