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      Conversations with mothers: exploring reasons for prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa.

      AIDS and Behavior

      Adult, Anti-Retroviral Agents, administration & dosage, Female, Focus Groups, HIV Infections, prevention & control, transmission, Health Knowledge, Attitudes, Practice, Health Services Accessibility, Humans, Infant, Newborn, Infectious Disease Transmission, Vertical, Maternal Health Services, organization & administration, Mothers, psychology, statistics & numerical data, Patient Acceptance of Health Care, Pregnancy, Pregnancy Complications, Infectious, Prejudice, Qualitative Research, Questionnaires, Socioeconomic Factors, South Africa

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          Reasons for incident cases of vertical HIV transmission in the era of free access to PMTCT in South Africa were investigated. This mixed-methods study was conducted in Soweto, South Africa from June-August, 2009. Birthmothers of HIV-infected infants born after 1 December 2008 were eligible. All participants completed an interviewer-administered questionnaire. Women also participated in a focus group (n = 10) or individual structured interview (n = 35). Mean age of participants (n = 45) was 28.7 years (SD = 5.4). Major findings are: (i) failure of per-guideline prescription of ARV strategies for infants (31%) and/or mothers (57%); (ii) maternal refusal of treatment (n = 5); (iii) preterm delivery (31%); (iv) delayed ANC attendance because of facility-related barriers and maternal apprehension around HIV testing; (v) fear of stigma; (vi) maternal difficulty with administering infant AZT (n = 9) and (vii) maternal confusion about infant feeding. A variety of individual, social, and structural factors must be addressed to optimize PMTCT service delivery in South Africa.

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