Improved access to services for the prevention of mother-to-child transmission of HIV (PMTCT) has decreased vertical HIV transmission. However parallel attention to women’s access to HIV care and treatment for themselves has often been lacking. This research used a combination of review of routine hospital data and a prospective follow-up study. It focused on maternity services, including ANC and delivery, in the two main government hospitals in Naivasha district, Kenya. It established that the proportion of women who tested HIV positive in maternity services who went on to be assessed as to whether they needed lifelong highly active antiretroviral therapy (HAART) for their own health was very low. There was considerable further attrition between women being assessed as needing HAART and actually being started on HAART. Between 2008 and 2010, 1,129 women tested HIV positive in Naivasha district’s two main government hospitals. Based on the levels of immunosuppression among this population, if they had all registered at the hospitals’ HIV clinic, done CD4 tests and, if necessary, started HAART 513 would have started treatment. Instead, 6 months after their diagnosis with HIV, only 27 (just 5%) had started HAART. Qualitative research and health systems analyses have pinpointed key client, health system, and societal factors that act as barriers to women starting HAART. The research also identified potential solutions that are needed to allow women to successfully negotiate the chain of steps between being diagnosed with HIV and successfully starting on HAART if needed.
Ferguson, L. Linking women who test HIV positive in antenatal and maternity services to long-term HIV care and treatment services in Kenya: Missed Opportunities. Evidence For Action Case Study No. 11 June (2011) , 2pp