Identifying opportunities to promote engagement in HIV care following childbirth in South Africa
PI: Melissa Watt
Co-PI: John Joska (University of Cape Town)
Investigator: Kathleen Sikkema
Funder: Duke Center for AIDS Research, 2015-2016
Site: Cape Town, South Africa
Nearly one in three pregnant women in South Africa is living with HIV. Under the new Option B protocol for prevention of mother to child transmission (PMTCT), all pregnant women initiate lifelong antiretroviral therapy (ART). Engagement of women in HIV care following childbirth has proven to be problematic, and may compromise the success of the Option B protocol. The goal of the proposed study is to conduct qualitative research to understand the complex array of factors that support or obstruct women's engagement with HIV care in the postpartum period, in order to identify specific intervention targets. The hypothesis is that mental health and social relationships play important roles in shaping long-term care engagement.
The study team will first review existing clinic protocols and policies affecting referrals and integration of care across relevant services (antenatal care, birthing and delivery, infant care, and HIV clinics) and conduct a minimum of 15 key informant interviews with providers and administrators at these sites. Second, the study team will conduct repeated in-depth interviews with 20 women who initiated ART during pregnancy. Interviews will be conducted during the last trimester of pregnancy and 3 months postpartum, with record review and selective follow-up at 6 months postpartum, in order to understand the factors that influence how women negotiate engagement in HIV care in the postpartum period. In order to provide broader perspectives on care engagement, women will also be asked to refer a support person for an interview. Third, the study team will conduct 4 focus group discussions with postpartum women who initiated lifetime ART during pregnancy, in order to identify opportunities for intervention to support continuous care engagement. The qualitative data will be analyzed in an iterative fashion, using a content analytic approach that involves analytic memos, data display matrices, thematic coding, and triangulation across data sources.
At the completion of this study, the study will have produced data to inform the development and pilot test of an intervention to support women's continuous engagement in HIV care following childbirth.