Exploratory analysis of the facility and community-level factors associated with PMTCT abandonment in central Mozambique

Background: Despite the major progress in the scale up of services to prevent mother-to-child transmission of HIV (PMTCT), existing constraints and limitations result in high rates of loss to follow up in most resource limited settings. Methods: To describe the most important health system or social/economic/cultural factors determining high rates of PMTCT loss to follow up in Central Mozambique, qualitative interviews were conducted at: two prenatal care sites with PMTCT services with a cohort of HIV+ pregnant women interviewed post HIV test and post partum (41); two community sites with women and men of unknown HIV status (30). Prospective data on adherence to PMTCT care was collected for the cohort of HIV+ women. Results: Researching HIV testing and care especially when it overlaps with pregnancy proved to be highly sensitive in this setting. Responses illuminated factors related to the understanding of HIV test during pregnancy (obligatory vs. optional). Most women had difficulties in anticipating future challenges immediately after diagnosis. In the community, PMTCT information was often available but women would avoid prenatal care because of fear of getting tested. Husbands were mentioned as their major support, although women felt often isolated. Other factors playing an important role in decisions about follow up included fears of abandonment, distrust of the health system, difficulty of disclosure, gender and domestic issues and the difficulty of breastfeeding cessation at six months. Conclusions: The understanding of HIV+ women and their environment should allow for more comprehensive and culturally responsive health policies to improve care.