Sociocultural factors that influence PMTCT in Cote d'Ivoire: A qualitative inquiry

Background: Cote d'Ivoire has one of the most serious HIV/AIDS epidemics in West Africa. In 2007, a program was initiated to integrate prevention of mother-to-child-transmission (PMTCT) services into routine antenatal care (ANC) at public health facilities in Bouaké, the country's second largest city. The purpose of this study was to understand how HIV-positive women's life circumstances and interactions with the health care system influence their ability to adhere to ARV prophylaxis during pregnancy, among those receiving care at integrated clinics.

Methods: A qualitative study was conducted using focused ethnography and principles of grounded theory as a methodological framework. Semi-structured interviews were carried out with 25 HIV-positive women and five midwives. Study participants were recruited from four public ANC clinics in Bouaké. Analysis was facilitated by qualitative data analysis software.

Results: Women are highly motivated to prevent HIV transmission to their babies, despite feeling isolated and burdened with responsibilities during pregnancy. Nearly all reported adhering to ARV prophylaxis during pregnancy and receiving prophylaxis at delivery. Infant feeding emerged as a more problematic PMTCT activity. Many described being unable to afford replacement formula and difficulty weaning at six months due to social stigma.

Conclusions: High self-reported adherence to ARV prophylaxis during pregnancy and delivery indicates the system of integrated PMTCT and ANC services is functioning well. To ensure comprehensive PMTCT services, the program should focus greater attention on infant feeding issues. These findings have implications for program scale-up in Cote d'Ivoire and for other PMTCT programs in similar limited-resource settings.