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Meta-Analysis
. 2014 Nov 5;9(11):e111421.
doi: 10.1371/journal.pone.0111421. eCollection 2014.

A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women

Ian Hodgson  1 , Mary L Plummer  2 , Sarah N Konopka  3 , Christopher J Colvin  4 , Edna Jonas  3 , Jennifer Albertini  5 , Anouk Amzel  6 , Karen P Fogg  7
Affiliations
Meta-Analysis

A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women

Ian Hodgson et al. PLoS One. .

Abstract

Background: Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women.

Methods: Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories.

Results: Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman's awareness and control (e.g., commitment to child's health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes.

Conclusions: To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow Diagram for Study Search and Inclusion.
See this image and copyright information in PMC

References

    1. Abdool-Karim Q, Abouzahr C, Dehne K, Mangiaterra V, Moodley J, et al. (2010) HIV and maternal mortality: turning the tide. Lancet 375: 1948–1949. - PubMed
    1. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, et al. (2010) Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 375: 1609–1623. - PubMed
    1. WHO UNICEF, UNFPA, World Bank (2010) Trends in Maternal Mortality: 1990 to 2008. Geneva: World Health Organisation.
    1. Zaba B, Calvert C, Marston M, Isingo R, Nakiyingi-Miiro J, et al. (2013) Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA). Lancet 381: 1763–1771. - PMC - PubMed
    1. Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, et al. (2014) Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2: e323–333. - PubMed

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