A framework addressing barriers to utilization of Elimination of Mother- to -Child Transmission of HIV services among pregnant women and lactating mothers in Gauteng Province

Abstract

Elimination of mother-to-child transmission of HIV (EMTCT) is a global health priority, ensuring that no child is born with HIV. Poor utilization of EMTCT services leads to burdensome consequences such as vertical transmission of HIV and an increase in maternal and neonatal mortality rates. Despite the progress made to reduce new HIV infections in children, barriers to the utilization of the Elimination of Mother-to-Child Transmission service remain the bottleneck that affects the program’s effectiveness. Pregnant and lactating women face many challenges that can contribute to loss of follow-up during their prenatal and postnatal care. This study developed a framework to enhance the utilization of the Elimination of Mother-to-Child Transmission of HIV services among pregnant women and lactating mothers in Gauteng province. A convergent parallel mixed methods design was used, where exploratory-descriptive qualitative approaches were concurrently run with the quantitative approach employing a cross-sectional descriptive design. A convenience sampling method was used to select these women based on accessibility and availability, ensuring the study's comprehensive coverage. A self-administered questionnaire was utilized to assess 681 pregnant and breastfeeding women. The data was analyzed using descriptive statistics using STATA 15.0. Validity and reliability issues were considered in the study to ensure the consistency of the work. For the qualitative approach, a convenience and purposive sampling method was used to select eligible pregnant and lactating women. A semi-structured interview guide was used to collect data until data saturation occurred after interviewing 25 participants. Qualitative data was analyzed thematically. Trustworthiness was ensured through Credibility, Confirmability, Transferability, and Dependability for the quantitative approach. Ethical principles were adhered to throughout the study. The findings were conceptualized using the health belief model. The results were interpreted and integrated. The combined qualitative and quantitative data gave a deeper understanding of the barriers to EMTCT utilization and perceived strategies to enhance its utilization. Strengths, Weaknesses, Opportunities, and Threats analysis were employed to guide the development of the framework using the BOEM model. Validation of the developed framework was done through stakeholder consultations and the Delphi technique. Experts and stakeholders participated in the process of validating and confirming the effectiveness of the developed framework to enhance the utilization of EMTCT services in Gauteng province. The framework can improve the utilization of EMTCT services among pregnant and lactating women with continued efforts to enhance the accessibility and utilization of EMTCT services, promoting the health and well-being of both mothers and their children. It is believed that the implementation of the developed framework will benefit all women of childbearing age throughout Gauteng province.