The authors declare that they have no competing interests.
ELS formulated the research study and design, collected and analysed the data, and wrote the first draft of the manuscript. SB provided substantial intellectual input in data analysis and interpretation, substantial intellectual input to the manuscript and approved the final version. IVDW provided substantial intellectual input to the conception and design of the study, and also provided substantial intellectual contribution to the manuscript. JGH provided substantial intellectual input to the design of the study, and also provided substantial intellectual contribution to the manuscript. FMC formulated the research study and design, provided substantial intellectual input to the data analysis and interpretation, to the manuscript and was responsible for oversight of the study overall. All authors read and approved the final manuscript.
Implementation of cotrimoxazole prophylaxis (CTX-p) among HIV-exposed infants (HEI) is poor in southern Africa. We conducted a study to investigate barriers to delivery of CTX-p to HEI in Zimbabwe at each step of the care cascade. Here we report findings of the qualitative component designed to investigate issues related to adherence conducted among women identified as HIV positive whose babies were started on CTX-p postnatally. Of note, Zimbabwe also provided nevirapine prophylaxis for HIV exposed babies, so the majority were giving nevirapine and CTX-p to their babies.
Between Feb–Dec 2011, the first 20 HIV infected mothers identified were invited for in-depth interview 4–5months postnatally. Interviews were recorded, transcribed, translated and analysed thematically.
All women desired their baby’s health above all else, and were determined to do all they could to ensure their wellbeing. They did not report problems remembering to give drugs. The baby’s apparent good health was a huge motivator for continued adherence. However, most women reported that their husbands were less engaged in HIV care, refusing to be HIV tested and in some cases stealing drugs prescribed for their wives for themselves. In two instances the man stopped the woman from giving CTX-p to the baby either because of fear of side effects or not appreciating its importance. Stigma continues to be an important issue. Mothers reported being reluctant to disclose their HIV status to other people so found it difficult to collect prescription refills from the HIV clinic for fear of being seen by friends/relatives. Some women reported that it was hard to administer the drugs if there were people around at home. Other challenges faced were stock-outs of CTX-p at the clinic, which occurred three times in 2011. The baby would then go without CTX-p if the woman could not afford buying at a private pharmacy.
The study highlights that adherence knowledge and desire alone is insufficient to overcome the familial and structural barriers to maintaining CTX-p. Improving adherence to CTX-p among HEI will require interventions to improve male involvement, reduce HIV stigma in communities and ensure adequate supply of drugs.