Experiences of mothers administering HIV post-exposure prophylaxis to their infants in Lusaka, Zambia

Lusaka, Mildred Mwewa (2018-03)

Thesis (MCur)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Background Effective Prevention of Mother-to-Child-Transmission (PMTCT) programs require women and their infants to have access to and to participate in a cascade of interventions including antenatal, postnatal and child health services. This includes HIV testing during pregnancy and the use of antiretroviral treatment (ART) with good adherence. HIV-positive mothers should be guided to practice safe childbirth, provide appropriate infant feeding, bring their infants for HIV testing and to administer antiretroviral (ARV) Post-Exposure Prophylaxis (PEP) to their infant’s post-delivery, for the prescribed period. Currently contextual information relating to the experiences of mothers administering ARV drugs for prophylactic purposes in Lusaka, Zambia is limited. The research endeavoured to explore the experiences of mothers administering PEP to their infants in Lusaka, Zambia. Methods The study followed a qualitative methodology with a descriptive design to explore the mothers’ experiences of administering PEP to their infants. Fifteen semi-structured individual interviews were conducted using open-ended questions. The targeted population were mothers that were required to administer PEP to their infants. Data analysis was guided by Creswell’s six-step model of data analysis. The study was approved by the Health Research Ethics Committee (HREC) of the University of Stellenbosch Faculty of Medicine and Health Sciences, the University of Zambia Bio-Medical Research Ethics Committee (UNZABREC) and the Ministry of Health (MOH). Trustworthiness was ensured by following the four principles of credibility, transferability, dependability and confirmability. Findings The participants experienced emotional stress and demonstrated a lack of knowledge and understanding about the need for PEP. Challenges experienced by them included difficulties with PEP administration, attending healthcare appointments, cultural and religious influences, lack of partner involvement and stigma and discrimination. Other social challenges that affected the administration of PEP were lack of disclosure to partners for fear of stigma and discrimination with possible abandonment. However, some participants’ own belief in the efficacy of PEP made them continue attending postnatal care. Conclusion Most women accepted and understood that PEP reduced the possibility of HIV infection of their infants and accepted it as part of the PMTCT programme. However, several challenges to PEP administration were identified. Administering PEP is emotionally challenging due to fear and apprehension that the baby may become HIV-positive. Although some women are supported in the administration of PEP, lack of knowledge, cultural and religious practices and stigma deter women from continuing to administer PEP. Long waiting times for laboratory results, insufficient supplies of Nevirapine and ineffective counselling were identified as health system barriers to continued PEP administration. Support for women to administer PEP can be enhanced through cultural empowerment, involving partners and family members and the training of healthcare workers.

AFRIKAANSE OPSOMMING: Agtergrond Effektiewe voorkoming van moeder-tot-kind (VMTKT) programme is noodsaaklik vir vrouens en hulle pasgeborenes om toegang tot ’n menigte intervensies, insluitende voorgeboortesorgdienste te kan kry. Dit sluit MIV-toetsing gedurende swangerskap en die gebruik van antiretrovirale behandeling (ARB) met toegewyde nakoming daarvan in. MIV-positiewe moeders behoort ingelig te word oor hoe om veilige kindergeboortes te hê, geskikte babavoeding te verskaf, hul pasgeborenes vir MIV-toetsing te neem en antiretrovirale (ARV) postblootstelling profilakse (PBP) na geboorte vir ’n voorgeskrewe periode toe te dien. Tans is kontekstuele inligting wat verband hou met die ervaringe van moeders wat ARB substanse toedien vir profilaktiese doelwitte in Lusaka, Zambia beperk. Hierdie navorsing het gepoog om die ervaringe van moeders wat PBP aan hul pasgeborenes in Lusaka, Zambia toedien, te ondersoek. Metode Hierdie studie het ’n kwalitatiewe metodologie met ’n beskrywende ontwerp gevolg om die moeders se ervaringe van die toediening van PBP aan hulle pasgeborenes te ondersoek. Vyftien semi-gestruktureerde onderhoude met oop-einde vrae is gevoer. Die teikengroep was moeders wat PBP aan hul pasgeborenes moes toedien. Data analise was gelei deur Crewell se ses-stap-model oor data analise. Die studie is goedgekeur deur die Gesondheidsnavorsingsetiekkomitee (GNEK) aan die Universiteit van Stellenbosch, Fakulteit van Medisyne en Gesondheidswetenskappe, die Universiteit van Zambia Biomediese Navorsingsetiekkomitee (UNZABNEK) en die Ministerie van Gesondheid (MVG). Betroubaarheid is verseker deur die vier beginsels van geloofwaardigheid, oordraagbaarheid, getrouheid en bevestigbaarheid. Resultate Die deelnemers het emosionele stres ervaar en het ’n gebrek aan kennis en begrip oor die behoefte aan PBP. Probleme met die toediening van PBP en nakoming van gesondheidsorgbesprekings, kulturele en religieuse invloede, ’n gebrek aan betrokkenheid van die saamwoonmaat, en stigma en diskriminasie, is die uitdagings wat deelnemers ervaar het. Ander maatskaplike uitdagings wat ’n effek op die toediening van PBP gehad het, was die gebrek aan openbaarmaking aan saamwoonmaats weens vrees vir verlating, en stigma en diskriminasie wat verder die gebrek aan ondersteuning van hulle saamwoonmaats bevorder het. Nietemin, sommige deelnemers se eie geloof in die effektiwiteit van PBP het daartoe aanleiding gegee dat hul voortgegaan het om postnatale sorg by te woon. Kulturele en religieuse invloede het ’n rol gespeel in die besluitneming ten opsigte van PBP-toediening wat postnatale bywoning geaffekteer het. Slotsom Die meeste vrouens het aanvaar en verstaan dat PBP die moontlikheid van MIV-infeksie kan verminder en dit as deel van die VMTKT-program aanvaar. Nietemin, verskeie uitdagings aangaande die toediening van PBP is geïdentifiseer. Die toediening van PBP is emosioneel-uitdagend weens die vrees en ongerustheid dat die pasgeborene MIV-positief kan raak. Alhoewel sommige vrouens ondersteuning het om PBP toe te dien, het die gebrek aan kennis, kulturele en religieuse praktyke en stigma verhinder dat sommige vrouens voortgegaan het om PEP toe te dien. Uitgerekte wagperiodes vir die verkryging van uitslae, onvoldoende voorraad van nevirapien en oneffektiewe berading, is geïdentifiseer as struikelblokke in die gesondheidsorg sisteem vir die voortsetting om PBP toe te dien. Ondersteuning aan vrouens om PBP toe te dien, kan versterk word deur kulturele bemagtiging, die betrokkenheid van saamwoonmaats en familielede en die opleiding van gesondheidsorgwerkers.

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