Table 8.
Changes over time: factors associated with PMTCT ARV uptake in qualitative research
| Number of studies (%) | ||||
|---|---|---|---|---|
| Factors | Fieldwork before 2007* (N=12) | Fieldwork in/after 2007** (N=11) | ||
| Individual | ||||
| Psychological | 7 | 58% | 3 | 27% |
| Denial/shock (following results)/depression | 7 | 58% | 2 | 18% |
| Fear (of being HIV positive/death/ARVs) | 2 | 17% | 2 | 18% |
| Desire to protect baby/self/family (facilitating) | 0 | 0% | 2 | 18% |
| Feeling better, well after taking cART (facilitating) | 0 | 0% | 1 | 9% |
| Knowledge and beliefs | 8 | 67% | 2 | 18% |
| Poor knowledge of HIV/MTCT/ARVs | 8 | 67% | 2 | 18% |
| Scepticism about ARVs | 5 | 42% | 1 | 9% |
| Obstetric factors and pregnancy-history | 3 | 25% | 2 | 18% |
| Sudden/unclear/early/night-time onset of labour | 3 | 25% | 2 | 18% |
| Post-delivery ill-health | 0 | 0% | 1 | 9% |
| Disease progression | 2 | 17% | 1 | 9% |
| Lack of symptoms – (perceived) disease severity | 2 | 17% | 1 | 9% |
| Personal management and supply of treatment | 3 | 25% | 4 | 36% |
| Lost/sold/stolen/forgetting/ran out of tablets | 3 | 25% | 2 | 18% |
| Difficulties administering infant treatment | 0 | 0% | 2 | 18% |
| Partner and Community | ||||
| Stigma | 9 | 75% | 9 | 82% |
| Disclosure issues/fear of disclosure | 8 | 67% | 9 | 82% |
| Relationship strains/violence | 1 | 8% | 5 | 45% |
| Fear of someone finding/seeing pills | 1 | 8% | 3 | 27% |
| Partners controlling finances | 1 | 8% | 1 | 9% |
| (Lack of) community/relative/partner support | 5 | 42% | 5 | 45% |
| Unwillingness of partners to test | 1 | 8% | 1 | 9% |
| Partner support (facilitating) | 0 | 0% | 2 | 18% |
| Cultural traditions and beliefs | 3 | 25% | 6 | 55% |
| Preference for TBAs/home-births | 3 | 25% | 2 | 18% |
| Traditional medicines/healers | 0 | 0% | 4 | 36% |
| Strong role of grandparents, associated beliefs | 0 | 0% | 2 | 18% |
| Scepticism regarding facilities in general | 1 | 8% | 1 | 9% |
| Health-systems | ||||
| Client–staff interactions | 8 | 67% | 4 | 36% |
| Staff attitudes/fear of negative attitudes | 7 | 58% | 4 | 36% |
| Trust in staff/helpful advice/support (facilitating) | 1 | 8% | 3 | 27% |
| Fear of lack of confidentiality | 1 | 8% | 0 | 0% |
| Health-worker–client power imbalance | 2 | 17% | 0 | 0% |
| Resources and infrastructure | 9 | 75% | 6 | 55% |
| Staff shortages | 6 | 50% | 6 | 55% |
| Long waiting times | 4 | 33% | 2 | 18% |
| Staff too busy/workload high/stressed | 5 | 42% | 2 | 18% |
| Lack of training/trained staff | 1 | 8% | 0 | 0% |
| Counselling sessions too short/too few | 1 | 8% | 0 | 0% |
| Staff failings | 1 | 8% | 2 | 18% |
| Failure to give NVP/poor instructions | 1 | 8% | 0 | 0% |
| Late bookings for delivery | 0 | 0% | 1 | 9% |
| Misunderstanding of client services required | 0 | 0% | 1 | 9% |
| Drug or supplies shortages | 2 | 17% | 3 | 27% |
| Delays (HIV tests, results, CD4 counts) | 1 | 8% | 2 | 18% |
| Privacy issues (layout) | 3 | 25% | 3 | 27% |
| Integration of services | 2 | 17% | 2 | 18% |
| Poor referral links/no/delayed referral to cART | 1 | 8% | 1 | 9% |
| Integration as a facilitating factor | 0 | 0% | 1 | 9% |
| Poor coordination between regional/local levels | 1 | 8% | 1 | 9% |
| Poor record keeping | 0 | 0% | 1 | 9% |
| Access to facilities/services | 7 | 58% | 5 | 45% |
| Transport issues/time and cost | 7 | 58% | 3 | 27% |
| Costs/perceived costs of services/treatment | 3 | 25% | 0 | 0% |
| Late first presentation to ANC | 0 | 0% | 2 | 18% |
*
Study numbers and fieldwork dates: 2 (2001), 3 (2005), 4 (2003), 5 (2006), 6 (2006), 7 (2006), 8 (2009), 9 (2005), 11 (1998–99), 15 (2006), 39 (1999–2001), 43 (2002–3).
**
Study numbers and fieldwork dates: 1 (2010—imputed one year before year of publication), 10 (2008), 12 (2008–9), 13 (2007–8), 14 (2009–10), 38 (2007), 37 (2007–8), 40 (2009), 41 (2008), 44 (2008–9).