Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis
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Objectives We investigated whether a woman’s role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d’Ivoire, South Africa, and Zambia. Our exposure of interest was the women’s role (active vs. not active) in decision-making about her healthcare, large household purchases, children’s schooling, and children’s healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00–2.89 all p < .05). However, associations between decision-making and antiretroviral use—for both mother and infant—were generally not significant. An exception was active decision-making in a woman’s own healthcare and reported maternal antiretroviral use (AOR 1.69, p < 0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services.
KeywordsWomen Prevention Children PMTCT cascade Decision-making Infant HIV testing
The Zambia, South Africa, and Cote d’Ivoire work was supported by contract T0906150021 from the US Centers for Disease Control and Prevention Global AIDS Program. The Cameroon work was supported by a Grant from The Bill & Melinda Gates Foundation (351-07), which was awarded through the Elizabeth Glaser Pediatric AIDS Foundation. Additional trainee and administrative support was provided by the U.S. National Institutes of Health (T32 HD075731, R25 TW009340, K24 AI120796, P30 AI050410). None of the funding agencies were involved in the design, conduct, or interpretation of this analysis, nor did they participate in the preparation, review, and approval of the manuscript.
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