Lack of Awareness Hindering HIV Vertical Transmission, Prevention Efforts

With the majority of pediatric HIV infections continuing to result from mother-to-child (MTCT), or vertical, transmission, educational efforts that focus on HIV prevention and awareness among women of reproductive age and those who are pregnant need to be stepped up via greater collaboration, access to higher-quality preventive services, and reduced stigma, reports European Journal of Midwifery.

In Nigeria, which was the focus of this study, “the rate of MTCT of HIV accounts for 30% of the global burden of MTCT of HIV,” the authors wrote, “and been linked with high prevalence of HIV in women of reproductive age and low prevention of MTCT coverage.”

The 182 women (mean [SD] age, 37.0 [6.5] years; 89% married) living with HIV who participated in this study attended a President’s Emergency Plan for AIDS Relief/AIDS Prevention Initiative in Nigeria clinic at Adeoyo Maternity Teaching Hospital and Saint Mary’s Catholic General Hospital, Ibadan, Oyo State from July to October 2018. Knowledge of MTCT prevention services was gauged with a questionnaire, with scores divided into 2 groups: 1 to 17 indicated poor knowledge and 18 to 37, good knowledge; the highest score was 37. Their perception of these services was also evaluated on a scale of 1 to 5 (1, strongly disagree; 5, strongly agree) and again divided into 2 score groups: 1 to 44 indicated a negative perception and 45 to 70, positive perception; the highest score was 70.

Results show that although a majority of the women had good knowledge (mean score, 24.27 [10.1]) and a positive perception (mean score, 52.15 [9.64]) of MTCT prevention services—at 74.2% and 89.0%, respectively—close to 60% did not take advantage of those services during pregnancy. Their most common reasons for lace of service uptake were stigma (16.5%), discrimination (15.4%), financial constraints (11.5%), partner noninvolvement (8.2%), poor-quality services (6.6%), and role of traditional birth attendants or socioeconomic status (both 3.8%).

In addition, links were found between lack of service uptake and these demographic variables: occupational status (7.1%), service satisfaction (6.6%), mother’s age (4.9%), partner’s educational level (3.8%), partner’s HIV status (3.3%), and discussions with partner (2.2%). Significant associations were also found for level of knowledge and MTCT service use (P = .012) and knowledge and marital status (P = .013).

MTCT can occur during pregnancy, labor, and delivery or while breastfeeding, and effective programs centered on preventing MTCT often include HIV testing during pregnancy, ensuring pregnant women living with HIV adhere to their antiretroviral treatment, and postnatal health care services.

The study authors point out that although their findings echo previous study results on good knowledge of MTCT prevention services, they also contrast other previous findings. A possible reason for this discordance, they propose, is that most of the women in the present study had a high level of education (secondary or tertiary), which supports research “that educational level and counseling during antenatal periods have aided in improving the knowledge of women on MTCT prevention services,” they wrote.

As for perception, again their findings both corroborate and conflict with previous studies, which the authors attribute to the influence a woman’s personal beliefs (spiritual or otherwise) have on their wanting to utilize MTCT prevention services.

“Findings suggest there is a need for improvement of knowledge and perception of HIV, MTCT, and MTCT prevention,” they concluded, “among women through counseling and antenatal education, thereby increasing MTCT prevention services uptake.”

They recommend that future studies investigate how effective MTCT prevention services are at reducing vertical transmission, compare perception and utilization of MTCT prevention services between rural and urban dwellers, and explore confounding variables that may have an impact on service utilization.

Reference

Saka AO, Onyeneho CA, Ndikom CM. Perception and utilization of prevention of mother-tochild transmission of human immunodeficiency virus (HIV) services among women living with HIV. Eur J Midwifery. 2021;5:1-6. doi:10.18332/ejm/140454