RESUMEN
OBJECTIVES: To evaluate quality of life (QoL) parameters among women categorized with a maternal near-miss during pregnancy. METHODS: The present prospective cohort study was conducted at a tertiary referral hospital in South Africa between April 1, 2013, and March 31, 2016. Patients who experienced maternal near-miss events were included and patients with uncomplicated low-risk pregnancies were enrolled as a control group. Various parameters were assessed using a WHO QoL questionnaire. RESULTS: The maternal near-miss and uncomplicated low-risk pregnancy (control) groups comprised 95 and 51 women. The maternal near-miss group scored lower than the control group in all four domains of the questionnaire (P<0.001). Overall, 42 (82%) women in the control group and 41 (43%) women in the maternal near-miss group desired future fertility (P<0.001). Women in the maternal near-miss group who had experienced perinatal loss scored lower in the physical health and well-being (P=0.009), psychological health and well-being (P=0.007), and environment (P=0.031) domains compared with women in the maternal near-miss group who experienced a live delivery. Nonetheless, QoL scores among women in the maternal near-miss group who had experienced perinatal loss remained lower than those reported by women in the control group (P<0.001). CONCLUSION: A maternal near-miss event during pregnancy was associated with reduced QoL, especially among women who had experienced perinatal loss.
Asunto(s)
Mortalidad Materna , Complicaciones del Embarazo/epidemiología , Calidad de Vida , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Complicaciones del Embarazo/etiología , Estudios Prospectivos , Sudáfrica , Centros de Atención Terciaria , Adulto JovenRESUMEN
OBJECTIVE: To understand the barriers delaying early prenatal care for women in South Africa. METHODS: A mixed-methods study was conducted at a center in Pretoria. RESULTS: Following interviews with 21 women at a prenatal clinic in Pretoria, a quantitative survey was completed by 204 postpartum women. During interviews, women described presenting late owing to contemplating induced abortion, fear of HIV testing, and fear of jealousy and bewitching. The survey results demonstrated that a majority of women (133 [65.2%]) reported knowledge of recommendations to present before 12weeks; however, the average gestational age at initial presentation was 19.1±7.7weeks. Women were more likely to present earlier if the pregnancy was planned (P=0.013) and were less likely to if they had at any point contemplated induced abortion (P=0.021). Fears of bewitching and harmful psychological stress owing to a positive HIV test result prevailed in both the interviews and the surveys. CONCLUSION: Significant efforts should be devoted to improving access to contraception and prepregnancy counseling in order to improve early prenatal care attendance. Similarly, addressing cultural concerns and fears regarding pregnancy is imperative in promoting early attendance.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud/psicología , Atención Prenatal/psicología , Aborto Inducido/psicología , Adulto , Miedo , Femenino , Edad Gestacional , Infecciones por VIH/psicología , Humanos , Embarazo , Embarazo no Planeado/psicología , Investigación Cualitativa , Proyectos de Investigación , Sudáfrica , Adulto JovenRESUMEN
OBJECTIVE: The objective of this study is to assess the efficacy of an intervention designed to promote resilience in young children living with their HIV-positive mothers. DESIGN/METHODS: HIV-positive women attending clinics in Tshwane, South Africa, and their children, aged 6-10 years, were randomized to the intervention (I) or standard care (S). The intervention consisted of 24 weekly group sessions led by community care workers. Mothers and children were in separate groups for 14 sessions, followed by 10 interactive sessions. The primary focus was on parent-child communication and parenting. Assessments were completed by mothers and children at baseline and 6, 12 and 18 months. Repeated mixed linear analyses were used to assess change over time. RESULTS: Of 390 mother-child pairs, 84.6% (I: 161 and S: 169) completed at least two interviews and were included in the analyses. Children's mean age was 8.4 years and 42% of mothers had been ill in the prior 3 months. Attendance in groups was variable: only 45.7% attended more than 16 sessions. Intervention mothers reported significant improvements in children's externalizing behaviours (ß = -2.8, P = 0.002), communication (ß = 4.3, P = 0.025) and daily living skills (ß = 5.9, P = 0.024), although improvement in internalizing behaviours and socialization was not significant (P = 0.061 and 0.052, respectively). Intervention children reported a temporary increase in anxiety but did not report differences in depression or emotional intelligence. CONCLUSION: This is the first study demonstrating benefits of an intervention designed to promote resilience among young children of HIV-positive mothers. The intervention was specifically designed for an African context and has the potential to benefit large numbers of children, if it can be widely implemented.
Asunto(s)
Terapia Conductista , Infecciones por VIH/psicología , Relaciones Madre-Hijo , Madres , Resiliencia Psicológica , Adulto , Niño , Femenino , Humanos , Masculino , Embarazo , Sudáfrica , Resultado del TratamientoRESUMEN
Efforts to prevent mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa have focused overwhelmingly on women, to the unintended exclusion of their male partners. A cross-sectional study was conducted in Tshwane, South Africa, to determine barriers to male-partner participation during PMTCT. In-depth interviews were conducted with 124 men whose partners had recently been pregnant, and five focus group discussions were held with physicians, nurses, HIV counselors, and community representatives. Qualitative analysis revealed that while most fathers believed that HIV testing is an important part of preparing for fatherhood, there are formidable structural and psychosocial barriers: the perception of clinics as not "male-friendly," a narrow focus on HIV testing instead of general wellness, and a lack of expectations and opportunities for fathers to participate in health care. Coupled with more family-oriented approaches to PMTCT, measurable improvements in the way that male partners are invited to and engaged in HIV prevention during pregnancy can help PMTCT programs to achieve their full potential.
Asunto(s)
Actitud Frente a la Salud , Padre/psicología , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Parejas Sexuales/psicología , Adulto , Consejo , Estudios Transversales , Femenino , Grupos Focales , Humanos , Recién Nacido , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Madres , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Investigación Cualitativa , Factores Socioeconómicos , Sudáfrica , Programas VoluntariosRESUMEN
Involvement of male partners may increase adherence to and improve outcomes of programs to prevent mother-to-child HIV transmission (PMTCT). Greater understanding of factors impeding male voluntary HIV counseling and testing (VCT) is needed. A cross-sectional study was conducted in Tshwane, South Africa. Semi-structured interviews were completed with men whose partners had recently been pregnant. Of 124 men who participated, 94% believed male HIV testing was important, but 40% had never been tested. Of those tested, 32% were tested during the pregnancy, while 37% were tested afterward. Fifty-eight percent of men reported that their female partners had disclosed their test results during pregnancy. A man's likelihood of testing during pregnancy was associated with prior discussion of testing in PMTCT, knowing the female partner had tested, and her disclosure of the test result (all p<0.05). In terms of increasing male-partner HIV testing rates, 74% of the men reported they would respond favorably to a written invitation for VCT from their partners. Based on themes that emerged during the interviews, six partner invitation cards to encourage male involvement in PMTCT were designed. Responses to the cards were elicited from 158 men and 409 women. One invitation card framed by the themes of fatherhood and the baby was selected by 41% of men and 31% of women as the most likely for women undergoing PMTCT to bring to their male partners and the most successful at encouraging men to be tested. In conclusion, this study found that a substantial proportion of men whose partners were recently pregnant had never been tested themselves; of those who had tested, most had done so only after the pregnancy. Encouraging partner communication and clinic attendance using an invitation card could facilitate increased male testing and participation in PMTCT.
Asunto(s)
Consejo/métodos , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Parejas Sexuales/psicología , Adulto , Comunicación , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Madres , Embarazo , Factores Sexuales , Conducta Sexual/psicología , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
We investigated the feasibility of using mobile phone text messaging (SMS) to promote adherence to antiretroviral therapy among HIV-infected pregnant women recently diagnosed with HIV. Seven HIV-positive women (15-33 weeks gestation) from two urban antenatal clinics received mobile phones and were invited to use text messaging to discuss HIV, health and pregnancy over a 12-week period. All participants were connected to each other and to a clinician who guided the group and answered questions via group SMS messaging. A total of 1018 individual messages were sent regarding medical and psychosocial topics related to HIV and mother-to-child HIV transmission. Participants sent an average of 16 messages per enrolled, technology-problem-free week. Half the messages (51%) concerned medical information, and the remainder concerned social comments or addressed psychological matters. Four post-intervention interviews with participants revealed overall satisfaction and participants recommended that the group be offered in the future. The pilot project's anonymity, non-rigid nature and remote access allowed it to overcome stigma and logistical challenges where a conventional support intervention would probably have failed.
Asunto(s)
Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Grupos de Autoayuda/estadística & datos numéricos , Envío de Mensajes de Texto/estadística & datos numéricos , Adulto , Estudios de Factibilidad , Femenino , Humanos , Proyectos Piloto , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estigma Social , Sudáfrica , Adulto JovenRESUMEN
The prevention of mother-to-child HIV transmission (PMTCT) is a complex challenge in heavily affected and resource-limited settings such as South Africa. Management of PMTCT requires a cascade of interventions that need to be addressed to effectively decrease the risk of HIV transmission to infants. This PMTCT cascade includes incremental components that can be shaped and influenced by the patient-provider relationship. The relationship that a pregnant woman has with her care providers may possibly affect decisions that she makes concerning her antenatal care and may, in turn, influence the quality of the care provided. A patient-provider relationship scale (PPRS) was developed in Pretoria, South Africa with two aims: first, to quantify the patient-provider relationship in an antenatal population in a resource-limited setting and provide preliminary evidence of its reliability and validity; and second, to determine whether the patient-provider relationship has an effect on PMTCT. The instrument was administrated in a cross-sectional pilot study to a group of women at discharge after delivery (n=192) at two major hospitals in South West Tshwane. Statistical analysis of the instrument showed high reliability (α=0.91) and preliminary evidence of its validity including significant associations with participants' attitudes regarding the functioning of the clinics and a single statement (the clinic staff "know me as a person," R=0.47, p<0.001) that has been shown previously to have a significant association with adherence to antiretroviral treatment. For HIV-positive participants, the PPRS was significantly associated with statements related to important components of the PMTCT cascade. In addition, those with substantially inadequate antenatal care (≤2 visits) and those who did not initiate highly active antiretroviral therapy, although eligible, had significantly poorer PPRS scores. The PPRS is a potentially useful, context-appropriate instrument that could have an important role in future research focused on improving PMTCT and decreasing the risk of HIV infection in children.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Seropositividad para VIH/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Servicios de Salud Materna/organización & administración , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/organización & administración , Relaciones Profesional-Paciente , Calidad de la Atención de Salud , Adulto , Consejo , Estudios Transversales , Femenino , Seropositividad para VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Madres , Educación del Paciente como Asunto , Proyectos Piloto , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Evaluación de Programas y Proyectos de Salud , Sudáfrica/epidemiologíaRESUMEN
The authors of this study evaluated a structured 10-session psychosocial support group intervention for newly HIV-diagnosed pregnant South African women. Participants were expected to display increases in HIV disclosure, self-esteem, active coping and positive social support, and decreases in depression, avoidant coping, and negative social support. Three hundred sixty-one pregnant HIV-infected women were recruited from four antenatal clinics in Tshwane townships from April 2005 to September 2006. Using a quasi-experimental design, assessments were conducted at baseline and two and eight months post-intervention. A series of random effects regression analyses were conducted, with the three assessment points treated as a random effect of time. At both follow-ups, the rate of disclosure in the intervention group was significantly higher than that of the comparison group (p<0.001). Compared to the comparison group at the first follow-up, the intervention group displayed higher levels of active coping (t=2.68, p<0.05) and lower levels of avoidant coping (t=-2.02, p<0.05), and those who attended at least half of the intervention sessions exhibited improved self-esteem (t=2.11, p<0.05). Group interventions tailored for newly HIV positive pregnant women, implemented in resource-limited settings, may accelerate the process of adjusting to one's HIV status, but may not have sustainable benefits over time.
Asunto(s)
Adaptación Psicológica , Seropositividad para VIH/psicología , Complicaciones Infecciosas del Embarazo/psicología , Autoimagen , Autorrevelación , Grupos de Autoayuda , Apoyo Social , Adulto , Reacción de Prevención , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Recursos en Salud , Humanos , Pobreza , Embarazo , Análisis de Regresión , Sudáfrica , Adulto JovenRESUMEN
To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal al clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20-4.47), prior discussion about testing (AOR 4.19; CI 2.34-7.49), having a partner with tertiary education (AOR 2.76; CI 1.29-5.88) and less experience of violence (AOR 0.48; CI 0.24-0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06-1.49), less financial dependence on partners (AOR 0.46; CI 0.25-0.85), and knowing someone with HIV (AOR 2.13; CI 1.20-3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84-0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72-0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help.
Asunto(s)
Revelación , Seropositividad para VIH/psicología , Complicaciones Infecciosas del Embarazo/psicología , Serodiagnóstico del SIDA , Demografía , Femenino , Humanos , Estudios Longitudinales , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Psicología , Factores de Riesgo , Parejas Sexuales , Factores Socioeconómicos , Sudáfrica , Encuestas y CuestionariosRESUMEN
HIV-positive pregnant women often do not disclose their serostatus to their partners, family and friends, creating potential barriers to preventing sexual transmission to partners and mother-to-child transmission through breastfeeding. This research explores recently diagnosed HIV-positive pregnant women's reasons for disclosure and non-disclosure of serostatus to various members of their social networks, as well as the consequences of their disclosure. Data were collected through open-ended questions as part of a semi-structured interview with 293 recently diagnosed HIV-positive pregnant women recruited from antenatal clinics in two townships in Tshwane, South Africa. A content analysis of responses showed that women weighed fear of abandonment and discrimination against their desire to raise risk awareness and their need for support. Partners most often responded to disclosure with disbelief and shock, whereas parents frequently exhibited emotional distress, but were still supportive, as were other relatives and friends. The women subsequently experienced low levels of adverse consequences after disclosure. The results can assist healthcare providers in understanding the complexity of pregnant women's decisions to disclose to various members of their social networks and emphasize the need for continued counselling and support.
Asunto(s)
Seropositividad para VIH/psicología , Complicaciones Infecciosas del Embarazo/psicología , Revelación de la Verdad , Adolescente , Adulto , Toma de Decisiones , Familia/psicología , Femenino , VIH-1 , Humanos , Embarazo , Prejuicio , Apoyo Social , SudáfricaRESUMEN
HIV-related stigma is a multidimensional concept which has pervasive effects on the lives of HIV-infected people as well as serious consequences for the management of HIV/AIDS. In this research three parallel stigma scales were developed to assess personal views of stigma, stigma attributed to others, and internalised stigma experienced by HIV-infected individuals. The stigma scales were administered in two samples: a community sample of 1,077 respondents and 317 HIV-infected pregnant women recruited at clinics from the same community in Tshwane (South Africa). A two-factor structure referring to moral judgment and interpersonal distancing was confirmed across scales and sample groups. The internal consistency of the scales was acceptable and evidence of validity is reported. Parallel scales to assess and compare different perspectives of stigma provide opportunities for research aimed at understanding stigma, assessing the consequences or evaluating possible interventions aimed at reducing stigma.