Amsterdam 2015
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| Abstract #2137 - Pregnancy and HIV | ||||
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Session: 14.6: Pregnancy and HIV (Symposium) on Wednesday @ 14.30-16.00 in C103 Chaired by Sibylle Niderost, Sandra Van Den Eynde Authors: Presenting Author: Mr Shandir Ramlagan - Human Sciences Research Council, South Africa |
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| Additional Authors: | ||||
| Aim: The biggest challenges to creating and maintaining a behavioural intervention are participant recruitment and retention. High loss-to-follow-up quickly leads to failures in research studies and more importantly failures in proven interventions. In trying to understand the loss-to-follow-up, too often we are left with missing quantitative data and more importantly missing participants. | ||||
| Method / Issue: This NIH funded Randomised Control Trial recruited 720 HIV positive women from 12 Community Health Centres (CHC’s) in rural Mpumalanga Province, South Africa. CHC’s were randomised into six Control and six Experimental sites. Consideration was taken to match clinics based on number of HIV positive pregnant patients seen the previous year. Study participants were followed from baseline (less than 6 months pregnant) to after the baby was born (6 weeks). Two group and one individual PMTCT sessions as well as a follow-up assessment were given prior to birth. This quantitative data, run on SPSS, will be presented showing the loss-to-follow-up from the screening of participants through 6 weeks post-natal. In order to understand the loss-to-follow-up, qualitative interviews with both male and female fieldworkers/interventionists from the CHC’s, the two project supervisor and the project manager were done. Qualitative interviews were transcribed verbatim, loaded into ATLAS.ti and analysed using grounded theory. | ||||
| Results / Comments: High loss to follow-up was seen at 32 weeks and 6 week post-natal. Strategies used to retain participants include appointment cards, reminder phone calls, WhatsApp messages, payment for assessment, refreshments for intervention sessions, gift bag prior to birth and the intervention knowledge itself. Reason for loss-to-follow-up include fear of stigma/discrimination, fear of loss of partner, miscarriage, do not feel clinic visits are necessary, and migrant labour hence going back home. Cultural reasons include coming very late in the pregnancy for first antenatal clinic visits as one “cannot tell that you are pregnant but it has to be seen for itself”, going back to the mothers home to give birth (up to 3 months), going to the in-laws house to show the newborn (up to a month), traditional rituals, going back to the village (homelands) during December and Easter holidays. | ||||
| Discussion: Interventions need to be planned so it ends before the planned birth and take into consideration the time spent away from home while the new family visits with the in-laws. An national integrated computer based system needs to be set up so patients are not lost when they move between clinics and provinces. More support is needed from the clinic nurses to drive the interventions. More research and community dialogs need to occur to raise awareness around presenting early at the clinic when pregnant. | ||||
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