Annabelle Gourlay|Isolde Birdthistle|Gitau Mburu|Kate Iorpenda|Alison Wringe
Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother?to?child transmission of HIV in sub?Saharan Africa: a systematic review
London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine|International HIV/AIDS Alliance|Lancaster University|International HIV/AIDS Alliance|London School of Hygiene & Tropical Medicine
objectives investigate synthesize reasons low access initiation adherence antiretroviral drugs mothers exposed babies prevention mothertochild transmission pmtct hiv subsaharan africa methods systematic literature review conducted four databases searched medline embase global health web science studies conducted subsaharan africa january 2000 september 2012 quantitative qualitative studies included met predefined criteria antiretroviral arv prophylaxis maternalinfant combination antiretroviral therapy art usageregistration hiv care treatment pregnancy included outcomes results 574 references identified 40 met inclusion criteria four references added searching reference lists included articles twenty studies quantitative 16 qualitative eight mixed methods fortyone studies conducted southern east africa two west africa none central africa one multiregional majority n 25 conducted combination art pmtct emphasized 2006 individuallevel poor knowledge hivartvertical transmission lower maternal educational level psychological issues following hiv diagnosis key barriers identified stigma fear status disclosure partners family community members communitylevel factors frequently cited barriers overall across time extent partnercommunity support another major factor impeding facilitating uptake pmtct arvs cultural traditions including preferences traditional healers birth attendants also common key healthsystems issues included poor staffclient interactions staff shortages service accessibility nonfacility deliveries conclusions longstanding healthsystems issues staffing service accessibility communitylevel factors particularly stigma fear disclosure lack partner support changed time continue plague pmtct programmes 10 years introduction potential pmtct programmes virtually eliminate vertical transmission hiv remain elusive unless barriers tackled prominence communitylevel factors review points importance communitydriven approaches improve uptake pmtct interventions although packages solutions addressing barriers different levels important