Advertisement

AIDS and Behavior

, Volume 23, Issue 2, pp 433–444 | Cite as

Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana

  • Kwame S. SakyiEmail author
  • Margaret Y. Lartey
  • Julie A. Dension
  • Caitlin E. Kennedy
  • Luke C. Mullany
  • Prince G. Owusu
  • Awewura Kwara
  • Pamela J. Surkan
Original Paper

Abstract

Care for low birthweight (LBW) infants can contribute to psychological difficulties and stigma among mothers living with HIV, creating challenges for antiretroviral therapy (ART) adherence and retention in HIV care. We explored how caring for LBW infants affects maternal ART adherence and retention in care. We conducted 30 in-depth interviews with postpartum women living with HIV in Accra, Ghana: 15 with LBW infants and 15 with normal birthweight (NBW) infants. Compared to mothers with NBW infants, mothers with LBW infants described how caring for their newborns led to increased caregiver burden, prolonged hospital stays, and stigma—contributing to incomplete ART adherence and missed clinical appointments. For a few women, care for LBW infants created opportunities for re-engagement in HIV care and motivation to adhere to ART. Results suggest women living with HIV and LBW babies in Ghana face increased challenges that impact their adherence to care and ART.

Keywords

Low birthweight Retention in HIV care ART adherence Postpartum women Qualitative 

Notes

Acknowledgements

The authors wish to thank Angela Yalley, Nathaniel Coleman, and Theresa Kusi for supporting data collection and Drs. Emily Hurley and Philip McNab for their comments on an earlier draft of the manuscript.

Funding

This study was funded by the 1) National Institutes of Health (Grant Numbers R25MH83620, T32DA1391); 2) the Johns Hopkins Center for Global Health; and 3) the Center for Qualitative Studies in Health and Medicine, Johns Hopkins University.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures preformed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obstained from all individual participants included in the study.

References

  1. 1.
    Reece R, Norman B, Kwara A, Flanigan T, Rana A. Retention to care of HIV-positive postpartum females in Kumasi, Ghana. J Int Assoc Provid AIDS Care. 2016;5(15):406–11.CrossRefGoogle Scholar
  2. 2.
    Clouse K, Pettifor A, Shearer K, Maskew M, Bassett J, Larson B, et al. Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa. Trop Med Int Health. 2013;18(4):451–60.CrossRefGoogle Scholar
  3. 3.
    Rana AI, Gillani FS, Flanigan TP, Nash BT, Beckwith CG. Follow-Up care among HIV-infected pregnant women in Mississippi. J Womens Health. 2010;19(10):1863–7.CrossRefGoogle Scholar
  4. 4.
    Nassali M, Nakanjako D, Kyabayinze D, Beyeza J, Okoth A, Mutyaba T. Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program. AIDS Care. 2009;21(9):1124–31.CrossRefGoogle Scholar
  5. 5.
    Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, et al. High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Trop Med Int Health. 2005;10(12):1242–50.CrossRefGoogle Scholar
  6. 6.
    Gibb DM, Kizito H, Russell EC, Chidziva E, Zalwango E, Nalumenya R, et al. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial. PLoS Med. 2012;9(5):e1001217.CrossRefGoogle Scholar
  7. 7.
    Nachega JB, Uthman OA, Anderson J, Peltzer K, Wampold S, Cotton MF, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012;26(16):2039–52.CrossRefGoogle Scholar
  8. 8.
    Mugavero MJ, Amico KR, Westfall AO, Crane HM, Zinski A, Willig JH, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr. 2012;59(1):86–93.CrossRefGoogle Scholar
  9. 9.
    Psaros C, Remmert JE, Bangsberg DR, Safren SA, Smit JA. Adherence to HIV care after pregnancy among women in sub-Saharan Africa: falling off the cliff of the treatment cascade. Curr HIV/AIDS Rep. 2015;12(1):1–5.CrossRefGoogle Scholar
  10. 10.
    Kim MH, Zhou A, Mazenga A, Ahmed S, Markham C, Zomba G, et al. Why did i stop? Barriers and facilitators to uptake and adherence to ART in option B+ HIV care in Lilongwe, Malawi. PLoS ONE. 2016;11(2):e0149527.CrossRefGoogle Scholar
  11. 11.
    Hodgson I, Plummer ML, Konopka SN, Colvin CJ, Jonas E, Albertini J, et al. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS ONE. 2014;9(11):e111421.CrossRefGoogle Scholar
  12. 12.
    Palos GR, Mendoza TR, Liao KP, Anderson KO, Garcia-Gonzalez A, Hahn K, et al. Caregiver symptom burden: the risk of caring for an underserved patient with advanced cancer. Cancer. 2011;117(5):1070–9.CrossRefGoogle Scholar
  13. 13.
    Schulz R, Newsom J, Mittelmark M, Burton L, Hirsch C, Jackson S. Health effects of caregiving: the caregiver health effects study: an ancillary study of the cardiovascular health study. Ann Behav Med. 1997;19(2):110–6.CrossRefGoogle Scholar
  14. 14.
    Kidman R, Thurman TR. Caregiver burden among adults caring for orphaned children in rural South Africa. Vulnerable Child Youth Stud. 2014;9(3):234–46.CrossRefGoogle Scholar
  15. 15.
    Mellins CA, Kang E, Leu CS, Havens JF, Chesney MA. Longitudinal study of mental health and psychosocial predictors of medical treatment adherence in mothers living with HIV disease. AIDS Patient Care STDS. 2003;17(8):407–16.CrossRefGoogle Scholar
  16. 16.
    Vigod SN, Villegas L, Dennis CL, Ross LE. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG. 2010;117(5):540–50.CrossRefGoogle Scholar
  17. 17.
    Xiao P-L, Zhou Y-B, Chen Y, Yang M-X, Song X-X, Shi Y, et al. Association between maternal HIV infection and low birth weight and prematurity: a meta-analysis of cohort studies. BMC Pregnancy Childbirth. 2015;15:246.CrossRefGoogle Scholar
  18. 18.
    Dreyfuss ML, Msamanga GI, Spiegelman D, Hunter DJ, Urassa EJN, Hertzmark E, et al. Determinants of low birth weight among HIV-infected pregnant women in Tanzania. Am J Clin Nutr. 2001;74(6):814–26.CrossRefGoogle Scholar
  19. 19.
    Laar AK, Ampofo W, Tuakli JM, Norgbe GK, Quakyi IA. Preterm delivery and low birth weight among neonates born to HIV-positive and HIV-negative Ghanaian women. J Public Health Epidemol. 2010;29(2):224–37.Google Scholar
  20. 20.
    Wei R, Msamanga GI, Spiegelman D, Hertzmark E, Baylin A, Manji K, et al. Association between low birth weight and infant mortality in children born to human immunodeficiency virus 1-infected mothers in Tanzania. Pediatr Infect Dis J. 2004;23(6):530–5.CrossRefGoogle Scholar
  21. 21.
    Coley JL, Msamanga GI, Fawzi MC, Kaaya S, Hertzmark E, Kapiga S, et al. The association between maternal HIV-1 infection and pregnancy outcomes in Dar es Salaam, Tanzania. BJOG. 2001;108(11):1125–33.Google Scholar
  22. 22.
    Montgomery KS. Nutrition and HIV-positive pregnancy. J Perinat Educ. 2003;12(1):42–7.CrossRefGoogle Scholar
  23. 23.
    Thaxton JE, Nevers TA, Sharma S. TLR-mediated preterm birth in response to pathogenic agents. Infect Dis Obstet Gynecol. 2010.  https://doi.org/10.1155/2010/378472.Google Scholar
  24. 24.
    Katz J, Lee ACC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013;382(9890):417–25.CrossRefGoogle Scholar
  25. 25.
    Castetbon K, Ladner J, Leroy V, Chauliac M, Karita E, De Clercq A, et al. Low birthweight in infants born to African HIV-infected women: relationship with maternal body weight during pregnancy: pregnancy and HIV Study Group (EGE). J Trop Pediatr. 1999;45(3):152–7.CrossRefGoogle Scholar
  26. 26.
    Ndirangu J, Newell ML, Bland RM, Thorne C. Maternal HIV infection associated with small-for-gestational age infants but not preterm births: evidence from rural South Africa. Hum Reprod. 2012;27(6):1846–56.CrossRefGoogle Scholar
  27. 27.
    Okyere E, Tawiah-Agyemang C, Manu A, Deganus S, Kirkwood B, Hill Z. Newborn care: the effect of a traditional illness, Asram, Ghana. Ann Trop Paediatr. 2010;30(4):321–8.CrossRefGoogle Scholar
  28. 28.
    Adejuyigbe EA, Odebiyi AI, Aina O, Bamiwuye S. Feeding and care of low-birthweight babies in two rural communities in south-western Nigeria. Matern Child Nutr. 2008;4(1):55–64.CrossRefGoogle Scholar
  29. 29.
    National Institutes of Health. FY 2016 National Institutes of Health Trans-NIH Plan for HIV-Related Research. In: Research OoA, editor. Bethesda, MD: Office of AIDS Research, National Institutes of Health; 2016.Google Scholar
  30. 30.
    Ghana Statistical Service, Ghana Health Service, ICF International. Ghana Demographic and Health Survey 2014. Rockville, Maryland, USA; 2014.Google Scholar
  31. 31.
    Center for Disease Control. Impact of an innovative approach to prevent mother-to-child transmission of HIV—Malawi, July 2011-September 2012. MMWR Morb Mortal Wkly Rep. 2013;62:148–51.Google Scholar
  32. 32.
    Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. London: Sage Publications Ltd; 2006.Google Scholar
  33. 33.
    Albrecht S, Semrau K, Kasonde P, Sinkala M, Kankasa C, Vwalika C, et al. Predictors of nonadherence to single-dose nevirapine therapy for the prevention of mother-to-child HIV transmission. JAIDS. 2006;41(1):114–8.Google Scholar
  34. 34.
    Stringer EM, Ekouevi DK, Coetzee D, Tih PM, Creek TL, Stinson K, et al. Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries. JAMA. 2010;304(3):293–302.CrossRefGoogle Scholar
  35. 35.
    Ware NC, Wyatt MA, Geng EH, Kaaya SF, Agbaji OO, Muyindike WR, et al. Toward an understanding of disengagement from HIV treatment and care in sub-Saharan Africa: a qualitative study. PLoS Med. 2013;10(1):e1001369.CrossRefGoogle Scholar
  36. 36.
    Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16(1):18588.CrossRefGoogle Scholar
  37. 37.
    Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.CrossRefGoogle Scholar
  38. 38.
    Baffour-Awuah A, Mwini-Nyaledzigbor PP, Richter S. Enhancing focused antenatal care in Ghana: an exploration into perceptions of practicing midwives. Int J Afr Nurs Sci. 2015;2:59–64.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Social and Behavioral Interventions Program, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Center for Learning and Childhood Development GhanaAccraGhana
  3. 3.Department of Public and Environmental Wellness, School of Health SciencesOakland UniversityRochesterUSA
  4. 4.Department of Medicine & TherapeuticsUniversity of Ghana School of Medicine & Dentistry, CHSAccraGhana
  5. 5.Department of International Health, Global Epidemiology and Disease ControlJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  6. 6.Division of Infectious Disease and Global Medicine, Department of MedicineUniversity of FloridaGainesvilleUSA

Personalised recommendations