Plain English summary
Background
Methods
Study sites
Models of PMTCT services
Study design
Eligibility
Sample size
Sampling procedure
Data collection methods
Data collection tools
Measures
Quantitative data management
Statistical analysis
Qualitative data analysis
Results
Socio-demographic and clinical characteristics
Characteristic | Frequencies | Proportions (%) |
---|---|---|
Overall | 507 | 100 |
Mityana hospital | 214 | 42.1 |
Masaka hospital | 183 | 36.2 |
Luwero H/C IV | 110 | 21.7 |
Age (years)* | ||
Mean(SD) | 25.1 (6.2) | |
15–24 | 265 | 52.2 |
25–29 | 145 | 28.7 |
30–44 | 97 | 19.2 |
Education level | ||
None or primary only | 262 | 51.5 |
Lower secondary (grade 1–4) | 209 | 41.4 |
Advanced secondary (grade 5–6) + vocational training | 32 | 6.3 |
University | 4 | 0.8 |
Marital status | ||
Never married | 61 | 12.1 |
Married | 406 | 80.0 |
Widowed/separated | 40 | 7.9 |
Occupation | ||
Agriculture | 96 | 18.9 |
Salaried | 29 | 5.7 |
Business/commercial | 171 | 33.6 |
Casual worker | 21 | 4.2 |
Not employed | 43 | 8.5 |
Housewife | 117 | 23.1 |
Other | 30 | 5.9 |
Currently taking ART | ||
Yes (Initiated ART within past four weeks) | 138 | 27.3 |
No (ART naive) | 369 | 72.7 |
Ever experienced HIV-related stigma, discrimination or violence | ||
Yes | 45 | 8.9 |
No | 462 | 91.1 |
Disclosure of HIV status
Characteristic | Follow up | |
---|---|---|
At month 2 post-enrolment Frequencies (%) | At month 4 post-enrolment Frequencies (%) | |
Partner testing | ||
Overall | 407 (100) | 389 (100) |
Yes | 195 (47.9) | 184 (47.3) |
No | 77 (18.9) | 93 (23.9) |
Don’t know | 135 (33.1) | 112 (28.8) |
How partner tested | ||
Tested together during ANC | 27 (12.0) | 31 (19.1) |
Tested together outside ANC | 34 (10.0) | 19 (11.7) |
Tested individually | 118 (55.0) | 112 (69.1) |
Partner HIV status | ||
HIV negative | 104 (53.6) | 86 (46.7) |
HIV positive | 82 (42.3) | 86 (46.7) |
Don’t know | 8 (4.1) | 12 (6.5) |
HIV status disclosed | ||
Yes | 353 (74.5) | 375 (83.7) |
Disclosure by study site | ||
Mityana hospital | 157 (79.7) | 156 (83.9) |
Masaka hospital | 132 (82.0) | 142 (88.8) |
Luwero H/C IV | 64 (64.0) | 77 (77.0) |
Persons most commonly disclosed to | ||
Spouses | 353 (59.5) | 374 (58.0) |
Sisters | 353 (36.8) | 373 (42.1) |
Mothers | 302 (37.7) | 330 (39.4) |
Friends | 353 (14.4) | 374 (18.7) |
Brothers | 352 (12.5) | 373 (18.0) |
Fathers | 269 (9.3) | 286 (11.9) |
Number of people disclosed to | ||
0 | 14 (3.9) | 11 (2.9) |
1 | 194 (54.8) | 187 (49.6) |
2 | 88 (24.9) | 104 (27.6) |
3 | 36 (10.2) | 36 (9.6) |
4 | 17 (4.8) | 25 (6.6) |
5 | 4 (1.1) | 12 (3.2) |
6 | 1 (0.3) | 2 (0.5) |
Self-reported adverse events | ||
HIV-related stigma | 35 (7.6) | 49 (10.8) |
Discrimination | 25 (5.4) | 24 (5.3) |
Violence | 18 (3.9) | 17 (3.7) |
HIV status disclosure and spousal support
Follow up visit 1 (2 months post-enrolment) | Follow up visit 2 (4 months post-enrolment) | |||
---|---|---|---|---|
Disclosed (n = 265)
| Not Disclosed (n = 65)
| Disclosed (n = 285)
| Not Disclosed (n = 35)
| |
Type of support, % | ||||
Gives me money to attend antenatal care | 82.9 | 81.5 | 55.3 | 64.7 |
Reminds me to attend antenatal care | 66.7 | 55.4 | 48.9 | 47.0 |
Escorts me to antenatal or postnatal care | 8.7 | 4.6 | 10.0 | 0 |
Reminds me to take ART | 85.3 | 0 | 46.3 | 0 |
Gives me money to pick-up ART | 58.1 | 0 | 55.4 | 0 |
Escorts me to refill ART | 8.4 | 0 | 10.6 | 0 |
Variable Name | Adjusted Analysis | |
---|---|---|
HIV status disclosure to sexual partner* | PRRa
| 95%CI |
Not disclosed to sexual partner | 1.0 | |
Disclosed to sexual partner |
1.17
|
1.02, 1.34
**
|
Age category | ||
15–24 | 1.0 | |
25–29 | 0.99 | 0.91, 1.08 |
30–44 | 1.00 | 0.91, 1.10 |
Marital status | ||
Never married | 1.0 | |
Married | 1.11 | 0.96, 1.28 |
Widowed/separated | 0.79 | 0.59, 1.05 |
Occupation | ||
Unemployed | 1 | |
Homemaker | 0.93 | 0.84, 1.03 |
Employed | 1.00 | 0.92, 1.08 |
Education level | ||
None or primary only | 1 | |
Lower (grade 1–4) secondary | 0.99 | 0.91, 1.07 |
Advanced (grade 5–6) secondary + vocational training |
1.17
|
1.05, 1.31
**
|
University | 0.97 | 0.69, 1.35 |
Type of visit | ||
Antenatal visit | 1 | |
First postnatal visit | 0.97 | 0.91, 1.05 |
Subsequent postnatal visits | 0.89 | 0.77, 1.03 |
Partner testing | ||
No/don’t know | 1 | |
Tested |
1.17
|
1.08, 1.26
**
|
Enrolment health facility | ||
Mityana hospital | 1 | |
Luwero H/C IV |
0.77
|
0.66, 0.90
**
|
Masaka hospital |
1.10
|
1.02, 1.17
**
|
Alcohol, drug/substance use | ||
No | 1 | |
Yes | 1.08 | 0.98, 1.20 |
Women’s experiences disclosing their HIV positive status
HIV-related stigma, discrimination or violence
HIV status disclosure to at least one person and associated negative outcomes
Variable Name | Adjusted Analysis | |
---|---|---|
HIV status disclosure to at least someone* | PRRa
| 95%CI |
Not disclosed to any one | 1.0 | |
Disclosed to at least someone | 0.89 | 0.56, 1.42 |
Age category | ||
15–24 | 1.0 | |
25–29 | 1.13 | 0.73, 1.74 |
30–44 | 1.40 | 0.86, 2.28 |
Marital status | ||
Never married | 1.0 | |
Married |
0.56
|
0.34, 0.92** |
Widowed/separated |
0.13
|
0.03, 0.53** |
Occupation | ||
Unemployed | 1.0 | |
Homemaker | 0.82 | 0.48, 1.41 |
Business/wage | 0.92 | 0.60, 1.42 |
Education level | ||
None or primary only | 1.0 | |
Lower (grade 1–4) secondary | 0.85 | 0.58, 1.27 |
Advanced (grade 5–6) secondary + vocational training | 0.82 | 0.36, 1.86 |
University | 1.82 | 0.98, 3.37 |
Type of visit | ||
Antenatal | 1.0 | |
First postnatal visit | 0.78 | 0.53, 1.17 |
Subsequent postnatal visits | 1.29 | 0.77, 2.15 |
Enrolment health facility | ||
Mityana hospital | 1.0 | |
Luwero H/C IV | 1.16 | 0.66, 2.02 |
Masaka hospital |
2.25
|
1.44, 3.52
|
Alcohol, drug/substance use | ||
No | 1.0 | |
Yes | 1.55 | 0.92, 2.59 |
Women’s experiences dealing with HIV-related stigma, discrimination and violence
When I was given the drug, I said …aha…how will I swallow this? The people I stay with at home have a lot of “lugambo” [gossip]. I don’t even use the container for the drugs. I put the drugs in a polythene bag and throw away the container. --Good ART adherer (Mityana hospital).
Health facility | Health care workers involved in PMTCT service delivery | Model of care for initiating Option B+ | Strategies for enhancing retention in care |
---|---|---|---|
Mityana Hospital | There are 8 health care workers involved in PMTCT: 3 nursing officers, 3 senior enrolled midwives, 2 expert clients and 2 data clerks. | At ANC, mothers are started on ARV on the same day they test positive. Formal postnatal care appointments are scheduled. Mothers are given ARVs monthly and after delivery until the baby is 6 months, thereafter, drug refills are given every 2 months or more based on the mother’s request. After delivery, women who are due for transfer from ANC are escorted by an expert client to the ART clinic and handed over to the provider on duty. | Mildmay Uganda facilitates expert clients to follow up clients who do not return for their ART refills. Mildmay Uganda also supports routine counselling and health education through monthly family support group meetings. Routine outreach activities are conducted. |
Luwero HC IV | There are 13 health workers involved in PMTCT: 2 medical officers, 9 registered midwives and 2 nursing assistants. | Mothers are started on ARVs during pregnancy although some who might refuse to start ART are asked to return when they are ready. Formal postnatal appointments are scheduled. Frequency of ART drug refills postpartum is every 2 months for mothers on Option B+ who are compliant and monthly for those who are not compliant. | PREFA facilitates expert clients to follow up clients who do not return for their ART refills. PREFA also supports routine counselling and health education through monthly family support group meetings. Routine outreach activities are conducted. |
Masaka RRH | There are 14 health workers involved in PMTCT: 2 nursing officers, 8 midwives, 2 counsellors and 2 expert clients | The decision to start taking ARVs entirely lies with the client. Mothers who are not ready are encouraged to return at a later date to start ARV therapy. All appointments with the mother are tied to those of the baby (mother-baby). EID mother-baby pair reviews are done monthly post-delivery for the first 6 months and continued 3-monthly until the baby is 18 months. | Uganda Cares facilitates expert client to follow up clients who do not return to the facility. No family support group meetings are provided. Routine outreaches activities are conducted. |
Going back to get other doses is a problem to me because most people know me and I don’t want anybody to see me, because they will go back and tell my parents. --Poor ART adherer (Luwero HCIV).
They say that the sick (meaning persons living with HIV) should not contest for a political position in society and should not discuss anything in public. They say aah…that one is going to die tomorrow. --Poor ART adherer (Luwero HCIV).