"This is My Life We are Talking About": Adaptive Strategies for HIV Care Retention and Treatment Adherence Among Postpartum Women Living with HIV in Cape Town, South Africa

Matern Child Health J. 2020 Dec;24(12):1454-1463. doi: 10.1007/s10995-020-02995-3.

Abstract

Introduction: Retaining postpartum women living with HIV in ongoing care is critical for the health of the mother-child dyad but low adherence to antiretroviral therapy (ART) and retention in HIV care are a global concern. This issue is particularly salient in South Africa, where approximately 50% of women fall out of the care cascade by 6 months postpartum. The purpose of this secondary analysis is to understand the strategies that women use to navigate HIV care during the postpartum period.

Methods: This study was conducted in Gugulethu, in Cape Town, South Africa. In-depth interviews were conducted with 21 study participants at 18-months postpartum. Participants were interviewed about their perceptions and experiences of their postpartum HIV care, and barriers and facilitators to their adherence and retention.

Results: All participants reported using care navigation strategies across a spectrum of individual, interpersonal and structural levels to remain retained in care and adherent to ART. Participants expressed the importance of individual empowerment and knowledge of treatment benefits for their HIV care. Interpersonal relationships were discussed as a pathway to access both psychosocial and tangible support. Participants described overcoming structural barriers to care through creative problem solving and identified opportunities for care delivery improvement.

Discussion: Participants described a wide range of overlapping and interconnected care navigation strategies. Consistent with the assets model, participants discussed their own capacity and that of their communities to engage in lifelong HIV care. Better understanding of potentially successful individual care navigation strategies should guide future intervention work.

Trial registration: ClinicalTrials.gov NCT01933477.

Keywords: Asset model; Care navigation; HIV; Health behavior; Postpartum.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Attitude to Health
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / psychology
  • Health Behavior*
  • Humans
  • Longitudinal Studies
  • Patient Acceptance of Health Care / ethnology
  • Patient Acceptance of Health Care / psychology*
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy
  • Retention in Care*
  • Treatment Adherence and Compliance*

Substances

  • Anti-HIV Agents

Associated data

  • ClinicalTrials.gov/NCT01933477