A Qualitative Analysis of the Barriers and Facilitators to Receiving Care in a Prevention of Mother-to-Child Program in Nkhoma, Malawi

Prior to 2011, uptake of PMTCT in Malawi remained low despite increased access to antiretrovirals. We sought to understand barriers to PMTCT in rural Malawi. Twenty-two HIV-infected pregnant and postpartum women in PMTCT programs were interviewed in Nkhoma, Malawi, between April-May 2010. All women were staged by WHO criteria or CD4 count as ineligible for three-drug treatment by Malawi’s HIV Guidelines at the time. The median age was 26 years (range 22-39) and 77% were married. Barriers to  accessing PMTCT care included transportation to clinic, stigma in the community leading to avoidance of HIV disclosure, food insecurity, and providers’ attitudes towards HIV-infected pregnant women. Given Malawi’s transition to Option B+ for PMTCT in which women are initiated on  antiretroviral therapy (ART) during pregnancy and continued for life,  strategies to improve access and retention will need to address barriers  and incorporate facilitators that motivate and retain women in HIV care. Afr J Reprod Health 2013 (Special Edition); 17[4]: 118-129).Keywords: HIV/AIDS, Malawi, maternal health, prevention of mother-to-child transmissio

The stability of neuropsychological test performance in a group of parenteral drug users

The stability of neuropsychological performance in a sample of drug abusers was investigatedfor a wide range of neuropsychological tests, using a test-retest paradigm with Idparenteral drug users. The battery administered included tests of general intellectualfunction, abstract reasoning, verbal memory, language, attention, visuospatial ability, set switching, speededperformance, and manipulative dexterity. Stability coefficients were of a moderate to high magnitude for most of the tests and were comparable to coefficients found in other studies of non-drug-users. Two exceptions, however, were the Selective Reminding Test and the Perdue Pegboard. Possible reasons for instability with these two tests are discussed. It is concluded that neuropsychological investigations of drug abusers can yield consistent and reliable data, although further studiesshould employ alternative and/or supplementary measures of verbal memory and motor function

Looking to the future: South African men and women negotiating HIV risk and relationship intimacy

This paper examines the approaches heterosexual men and women in South Africa use to engage their partners in discussions of HIV and risk factors in their relationships. These strategies entail balancing the risks of infection while managing the challenges of maintaining a relationship. In a context in which there is a great deal of insecurity in relationships it is especially challenging to discuss HIV risks with partners. Our findings reveal that concerns about children or the desire to have children provided a legitimate basis for discussing HIV risk with partners. The focus of these discussions is on the future for their children. Research in South Africa should attend to men's and women's desires to have and to raise children. HIV prevention and treatment programmes can capitalise on concerns regarding children, and the future of the family, to engage men and women in discussing mutually acceptable strategies for preventing infection and ensuring safe conception.

A Qualitative Analysis of the Barriers and Facilitators to Receiving Care in a Prevention of Mother-to-Child Program in Nkhoma, Malawi

Prior to 2011, uptake of PMTCT in Malawi remained low despite increased access to antiretrovirals. We sought to understand barriers to PMTCT in rural Malawi. Twenty-two HIV-infected pregnant and postpartum women in PMTCT programs were interviewed in Nkhoma, Malawi, between April-May 2010. All women were staged by WHO criteria or CD4 count as ineligible for three-drug treatment by Malawi’s HIV Guidelines at the time. The median age was 26 years (range 22-39) and 77% were married. Barriers to accessing PMTCT care included transportation to clinic, stigma in the community leading to avoidance of HIV disclosure, food insecurity, and providers’ attitudes towards HIV-infected pregnant women. Given Malawi’s transition to Option B+ for PMTCT in which women are initiated on antiretroviral therapy (ART) during pregnancy and continued for life, strategies to improve access and retention will need to address barriers and incorporate facilitators that motivate and retain women in HIV care.Avant 2011, l'adoption de la PTME au Malawi est restée faible malgré un accès accru aux antirétroviraux. Nous avons cherché à comprendre les obstacles à la PTME dans les régions rurales du Malawi. Vingt-deux femmes enceintes et les femmes du post-partum qui sont infectées par le VIH et qui suivaient les programmes de PTME ont été interrogées à Nkhoma, Malawi, entre avril et mai 2010. Toutes les femmes ont été mises en scène par des critères de l’OMS ou des CD4 qui comptent comme inéligible pour un traitement de trois médicaments par les lignes directrices du VIH au Malawi à l'époque. L'âge médian était de 26 ans (extrêmes: 22-39) et 77 % étaient mariés. Les obstacles à l'accès aux soins de la PTME comprennent le transport à la clinique, la stigmatisation dans la communauté, ce qui mène à l'évitement de la divulgation, l'insécurité alimentaire et les attitudes des prestataires envers les femmes enceintes infectées par le VIH. Compte tenu de la transition du Malawi vers l'Option B + de la PTME dans laquelle les femmes sont initiées à la thérapie antirétrovirale (ART) au cours de la grossesse et qui continué à vie, il faudra que des stratégies pour améliorer l'accès et la rétention surmontent les obstacles et à intégrer les animateurs qui motivent et retiennent les femmes en matière de soins du VIH

Uthando Lwethu ('our love'): a protocol for a couples-based intervention to increase testing for HIV: a randomized controlled trial in rural KwaZulu-Natal, South Africa.

BACKGROUND: Couples-based HIV counseling and testing (CHCT) is a proven strategy to reduce the risk of HIV transmission between partners, but uptake of CHCT is low. We describe the study design of a randomized controlled trial (RCT) aimed to increase participation in CHCT and reduce sexual risk behavior for HIV among heterosexual couples in rural KwaZulu-Natal, South Africa. We hypothesize that the rate of participation in CHCT will be higher and sexual risk behavior will be lower in the intervention group as compared to the control. METHODS/DESIGN: Heterosexual couples (N=350 couples, 700 individuals) are being recruited to participate in a randomized trial of a couples-based intervention comprising two group sessions (one mixed gender, one single gender) and four couples' counseling sessions. Couples must have been in a relationship together for at least 6 months. Quantitative assessments are conducted via mobile phones by gender-matched interviewers at baseline, 3, 6, and 9 months post-randomization. Intervention content is aimed to improve relationship dynamics, and includes communication skills and setting goals regarding CHCT. DISCUSSION: The Uthando Lwethu ('our love') intervention is the first couples-based intervention to have CHCT as its outcome. We are also targeting reductions in unprotected sex. CHCT necessitates the testing and mutual disclosure of both partners, conditions that are essential for improving subsequent outcomes such as disclosure of HIV status, sexual risk reduction, and improving treatment outcomes. Thus, improving rates of CHCT has the potential to improve health outcomes for heterosexual couples in a rural area of South Africa that is highly impacted by HIV. The results of our ongoing clinical trial will provide much needed information regarding whether a relationship-focused approach is effective in increasing rates of participation in CHCT. Our intervention represents an attempt to move away from individual-level conceptualizations, to a more integrated approach for HIV prevention. TRIAL REGISTRATION: Study Name: Couples in Context: An RCT of a Couples-based HIV Prevention InterventionClinicalTrials.gov identifier: NCT01953133.South African clinical trial registration number: DOH-27-0212-3937