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Abstract
Worldwide, rates of antiretroviral therapy adherence and retention in HIV care (defined henceforth as engagement in HIV care) are generally lower for women in the postpartum period than during pregnancy. To date, studies on women’s engagement in HIV care in the postpartum period have not examined the role of low birthweight. In Ghana, caregivers of low birthweight (LBW) infants may be at risk of low engagement because they are a socially vulnerable group. They often are impoverished, experience social stigma for having small babies, and have high depression rates.
This dissertation draws on qualitative interviews with 30 mothers living with HIV (15 with LBW and 15 with normal birthweight infants) in Ghana. It explores how the experiences of caregivers with LBW infants influence their ability to seek HIV treatment and adhere to antiretroviral therapy. Further, it highlights the potential key drivers of retention loss in the postpartum period. All the women in the study were receiving HIV treatment from two tertiary facilities in Accra implementing Option B plus.
Participants’ narratives indicate that, in Ghana, social (stigma relating to HIV and baby’s size), interpersonal (newborn health concerns) and economic (transportation costs) forces appear to have a greater impact on retention loss in the postpartum period than individual level factors (beliefs and motivations). In addition, they show that mothers with LBW infants are likely to face more challenges with engagement in HIV care than mothers with normal birthweight infants.
Our findings suggest that for sustained engagement of postpartum women in HIV care, a multifaceted approach is needed. Interventions should aim to integrate mother, HIV, and child health services; reduce the financial cost of accessing ART in the postpartum period, and address stigma. Mothers with LBW infants may need additional support to keep HIV-related clinical appointments and adhere to ART.