Evaluation of Adherence to Short Course Antiretroviral Prophylaxis for PMTCT in Francistown, Botswana
Council researchers assessed the quality of the post-test counseling and education women receive regarding HIV, antiretroviral prophylaxis, and therapy and explored barriers to starting and completing antiretroviral prophylaxis among women in Botswana.
Botswana’s national program for prevention of mother-to-child transmission (PMTCT) of HIV has been functioning nationwide since 2001. PMTCT program coverage has increased steadily since the program’s inception, but data indicate that many women identified as HIV-positive during pregnancy do not receive appropriate antiretroviral (ARV) prophylaxis or therapy. The content of post-test counseling and education has not been formally evaluated, and there are no data on women’s adherence to prescribed prophylaxis regimens.
To address these gaps, Horizons researchers assessed the quality of the post-test counseling and education women receive regarding HIV and ARV prophylaxis and therapy, and explored barriers to starting and completing ARV prophylaxis among women in Botswana’s PMTCT program.
Key findings include:
- Provider-initiated routine HIV testing in the antenatal care setting has increased coverage and is both feasible and acceptable.
- Most HIV-positive pregnant women received one post-test counseling session.
- Providers had different notions of what information was essential to communicate to HIV-positive pregnant women; observed counseling sessions revealed incomplete delivery of important information.
- Most women recalled that key topics had been discussed during post-test counseling sessions, but gaps remained.
- More than eight out of ten HIV-positive women reported starting ARV prophylaxis during their pregnancy.
- Reported adherence to zidovudine (AZT) for PMTCT was generally good, but 30–40 percent of women missed at least some doses during their pregnancies.
- The majority of women reported that adherence to their AZT regimen was easy.
- The majority of respondents refill their AZT when they have little or none left, and women were given inconsistent supplies of pills.
- Infant AZT was provided consistently at the delivery sites, and the vast majority of women reported adhering to the infant AZT regimen.
This evaluation was designed as an opportunity for policymakers and program managers in Botswana to learn about the quality of HIV post-test counseling, education of HIV-positive pregnant women, and any existing problems with ARV prophylaxis adherence. The findings can be used to help design and test activities to improve the quality of counseling that HIV-positive pregnant women receive, to increase the number of women starting ARV prophylaxis or therapy, and to improve adherence to these medications. For stakeholders in other resource-constrained settings, this evaluation demonstrates the feasibility of administering a more complex regimen within antenatal care/maternal child health care. While different challenges may arise depending on contextual factors, the lessons learned from Botswana can be applied to other settings.
Evaluation of HIV counseling and testing in ANC settings and adherence to short course antiretroviral prophylaxis for PMTCT in Francistown, Botswana (PDF)
Baek,Carolyn; Creek,Tracy; Jones,Lee Ann; Apicella,Louis; Redner,Jennifer; Rutenberg,Naomi
Horizons Final Report
Publication date: 2009
Project Stats
Location: Botswana (Francistown)
Program(s):
HIV and AIDS
Topic(s):
HIV care, support, and treatment
HIV prevention
PMTCT and pediatric HIV
Duration: 8/2005 - 12/2006
Population Council researchers:
Naomi Rutenberg
Non-Council collaborators:
Carolyn Wilson (Premiere Personnel)
Khumo Seipone (Botswana National PMTCT Program, Family Health Division, MOH)
Molly Smit (Government of Botswana and Centres for Disease Control and Prevention)
Monica Smith (Government of Botswana and Centres for Disease Control and Prevention)
Nathan Shaffer (Centers for Disease Control and Prevention)
Peter Kilmarx (Government of Botswana and Centres for Disease Control and Prevention)
Ralph Ntumy (Government of Botswana and Centres for Disease Control and Prevention)
Tracy Creek (Centers for Disease Control and Prevention)
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