PMID- 29364979
OWN - NLM
STAT- MEDLINE
DCOM- 20180226
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 13
IP  - 1
DP  - 2018
TI  - Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV 
      services in Kibera, Kenya: Barriers to engaging and remaining in care.
PG  - e0191463
LID - 10.1371/journal.pone.0191463 [doi]
LID - e0191463
AB  - Within the first year of implementation, 43% of women who tested HIV positive at 
      their first antenatal care visit were no longer retained and being followed in 
      the free prevention of mother to child transmission (PMTCT) of HIV program 
      offered by the Kenyan Ministry of Health and Medecins Sans Frontieres in the 
      informal settlement of Kibera, Nairobi. This study aimed to explore barriers to 
      enrolling and remaining engaged in PMTCT services throughout the pregnancy and 
      postpartum periods. Qualitative data from 31 focus group discussions and 35 
      in-depth interviews across six stakeholder groups that included women, men, and 
      PMTCT service providers were analyzed. Using an inductive exploratory approach, 
      four researchers coded the data and identified key themes. Five themes emerged 
      from the data that may influence attrition from PMTCT service in this setting: 1) 
      HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 
      4) disclosure of HIV status, and 5) male partner support for PMTCT services. A 
      new HIV diagnosis during pregnancy immediately triggered an ongoing risk 
      assessment of perceived hazards in the home, community, and clinic environments 
      that could occur as a result of female participation in PMTCT services. Male 
      partners were a major influence in this risk assessment, but were generally 
      unaware of PMTCT services. To preserve relationships with male partners, meet 
      community expectations of womanhood, and maintain confidentiality while following 
      recommendations of healthcare providers, women had to continuously weigh the 
      risks and benefits of PMTCT services and interventions. Community-based HIV 
      testing and PMTCT education, male involvement in antenatal care, and counseling 
      customized to assist each woman in her own unique risk assessment, may improve 
      uptake of and retention in care and optimize the HIV prevention benefit of PMTCT 
      interventions.
FAU - Thomson, Kerry A
AU  - Thomson KA
AUID- ORCID: 0000-0002-1958-200X
AD  - Medecins Sans Frontieres (MSF) Operational Centre Brussels, Nairobi, Kenya.
FAU - Telfer, Barbara
AU  - Telfer B
AD  - Medecins Sans Frontieres (MSF) Operational Centre Brussels, Nairobi, Kenya.
FAU - Opondo Awiti, Patricia
AU  - Opondo Awiti P
AD  - Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
FAU - Munge, Jane
AU  - Munge J
AD  - Medecins Sans Frontieres (MSF) Operational Centre Brussels, Nairobi, Kenya.
FAU - Ngunga, Mathew
AU  - Ngunga M
AD  - Survey Research Team, Nairobi, Kenya.
FAU - Reid, Anthony
AU  - Reid A
AD  - Medecins Sans Frontieres (MSF) Operational Centre Brussels, Luxembourg City, 
      Luxembourg.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180124
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Child
MH  - Female
MH  - HIV Infections/complications/*prevention & control/*transmission
MH  - Health Knowledge, Attitudes, Practice
MH  - Humans
MH  - Infant, Newborn
MH  - Infectious Disease Transmission, Vertical/*prevention & control
MH  - Kenya
MH  - Male
MH  - Organizations
MH  - Patient Participation
MH  - Pregnancy
MH  - *Pregnancy Complications, Infectious/therapy
MH  - Prenatal Care
MH  - Risk Assessment
MH  - Risk Management
MH  - Sexual Partners/psychology
MH  - Truth Disclosure
PMC - PMC5783372
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2018/01/25 06:00
MHDA- 2018/02/27 06:00
PMCR- 2018/01/24
CRDT- 2018/01/25 06:00
PHST- 2016/03/24 00:00 [received]
PHST- 2018/01/05 00:00 [accepted]
PHST- 2018/01/25 06:00 [entrez]
PHST- 2018/01/25 06:00 [pubmed]
PHST- 2018/02/27 06:00 [medline]
PHST- 2018/01/24 00:00 [pmc-release]
AID - PONE-D-16-12197 [pii]
AID - 10.1371/journal.pone.0191463 [doi]
PST - epublish
SO  - PLoS One. 2018 Jan 24;13(1):e0191463. doi: 10.1371/journal.pone.0191463. 
      eCollection 2018.