Patient-Reported Factors Facilitating Participation in Prevention of Mother to Child Transmission of HIV Programs in Kara, Togo, West Africa


Background: Despite efforts to expand prevention of mother-to-child transmission (PMTCT) of HIV in resource-limited settings, only 53% of women in sub-Saharan Africa receive adequate PMTCT services. Understanding factors that enable successful program completion are crucial to improving adherence rates to PMTCT programs in these settings. Using a positive deviance approach, we explored patient and provider’s perspectives on factors enabling women to successfully access and adhere to PMTCT services to identify areas of program improvement and further reduce HIV transmission. Methods: Semi-structured interviews were conducted with 11 health care workers (HCWs) at two health centers in Kara, Togo and 34 women who had successfully completed the PMTCT program at those facilities. Women were identified using purposive sampling and content theme analysis was used to analyze the data. Results: Knowledge and belief in the potential to give birth to an HIV-negative child, supported by facilitating factors on the individual and community levels, was the cornerstone to women’s PMTCT program success. Effective program education and peer-to-peer interactions fostered the participants’ knowledge and belief in PMTCT, with the resulting internal motivation driving continued participation and adherence. The welcoming environment, availability of peer support groups and financial assistance from the health facility, further facilitated success, with women using this facility-based community to seek advice and support from HCWs and peers. Financial, physical, and emotional support from relatives was also important in ensuring unhindered access. Finally, the faith-based communities’ acceptance and support for HIV-positive women further encouraged participants to adhere to the program. Conclusion: Understanding and believing in the ability to have an HIV-negative baby was the most important facilitator for PMTCT program adherence. This led to internal motivation that was continually reinforced through facility and community supportive environments focused on addressing barriers. Efforts to improve PMTCT success should focus on all of these factors through a patient-centered approach.

Share and Cite:

Loccoh, E. , Azouma, D. , Jr., K. , Schechter, J. , Gbeleou, S. and Hirschhorn, L. (2014) Patient-Reported Factors Facilitating Participation in Prevention of Mother to Child Transmission of HIV Programs in Kara, Togo, West Africa. World Journal of AIDS, 4, 446-457. doi: 10.4236/wja.2014.44053.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Tolle, M. and Dewey, D. (2010) Prevention of Mother-to-Child Transmission of HIV Infection. In: Baylor College of Medicine, Ed., HIV Curriculum for the Health Professional, Baylor International Pediatric AIDS Initiative, Houston, 90-119.
[2] Shroufi, A., Mafara, E., Saint-Sauveur, J.F., Taziwa, F. and Vinoles, M.C. (2013) Mother to Mother (M2M) Peer Support for Women in Prevention of Mother to Child Transmission (PMTCT) Programmes: A Qualitative Study. PLoS One, 8, e64717.
[3] Ware, N.C., Wyatt, M.A. and Bangsberg, D.R. (2006) Examining Theoretic Models of Adherence for Validity in Resource-Limited Settings. A Heuristic Approach. Journal of Acquired Immune Deficiency Syndromes, 43, S18-S22.
[4] Direction Regionale de la Sante (DRS), Region de la Kara (2011) Rapport des Activites Sanitaires de la Region de la Kara 2011. DRS, Lome, 43-46.
[5] Bwirire, L.D., et al. (2008) Reasons for Loss to Follow-Up among Mothers Registered in a Prevention-of-Mother-to- Child Transmission Program in Rural Malawi. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102, 1195-1200.
[6] Viadro, C. (2008) Mothers’ Support Groups in Ethiopia: A Peer Support Model to Address the Needs of Women Living with HIV. Intra Health.
[7] Bradley, E.H., Curry, L.A., Ramanadhan, S., Rowe, L., Nembhard, I.M. and Krumholz, H.M. (2009) Research in Action: Using Positive Deviance to Improve Quality of Health Care. Implement Science, 4, 25.
[8] Hope through Health. Prevention of Mother to Child Transmission of HIV.
[9] World Health Organization (2010) Antiretroviral Drugs for Treating Pregnant Women and Preventing Infection in Infants: Recommendations for a Public Health Approach.
[10] The World Health Organization (2010) New Guidance on Prevention of Mother-to-Child Transmission of HIV and Infant Feeding in the Context of HIV.
[11] Suter, W. (2012) Qualitative Data, Analysis, and Design. In: Newton Suter, W., Ed., Introduction to Educational Research: A Critical Thinking Approach, Sage Publications, Thousand Oaks, 342-386.
[12] Berg, B. (2007) An Introduction to Content Analysis. In: Berg, B.L., Ed., Qualitative Research Methods for the Social Sciences, Allyn and Bacon, Boston, 238-267.
[13] Kumarasamy, N., Safren, S.A., Raminani, S.R., Pickard, R., James, R., Krishnan, A.K., et al. (2005) Barriers and Facilitators to Antiretroviral Medication Adherence among Patients with HIV in Chennai, India: A Qualitative Study. AIDS Patient Care STDS, 19, 526-537.
[14] Matthews, L.T., Crankshaw, T., Giddy, J., Kaida, A., Psaros, C., Ware, N.C., et al. (2012) Reproductive Counseling by Clinic Healthcare Workers in Durban, South Africa: Perspectives from HIV-Infected Men and Women Reporting Serodiscordant Partners. Infectious Diseases in Obstetrics and Gynecology, 2012, Article ID: 146348.
[15] Frank, J. and Duncan, N. (2009) Speaking to Experts and Patients: Recommendations for Improving Antiretroviral Therapy (ART) Adherence. Health SA Gesondheid, 14, 9 p.
[16] Chinkonde, J.R., Sundby, J. and Martinson, F. (2009) The Prevention of Mother-to-Child HIV Transmission Programme in Lilongwe, Malawi: Why Do So Many Women Drop Out. Reproductive Health Matters, 17, 143-151.
[17] Muchedzi, A., Chandisarewa, W., Keatinge, J., Stranix-Chibanda, L., Woelk, G., Mbizvo, E. and Shetty, A.K. (2010) Factors Associated with Access to HIV Care and Treatment in a Prevention of Mother to Child Transmission Programme in Urban Zimbabwe. Journal of the International AIDS Society, 13, 38.
[18] Otolok-Tanga, E., Atuyambe, L., Murphy, C.K., Ringheim, K.E. and Woldehanna, S. (2007) Examining the Actions of Faith-Based Organizations and Their Influence on HIV/AIDS-Related Stigma: A Case Study of Uganda. African Health Sciences, 7, 55-60.
[19] Nyasulu, J.Y. and Nyasulu, P. (2011) Barriers to the Uptake of Prevention of Mother to Child Transmission (PMTCT) Services in Rural Blantyre and Balaka Districts, Malawi. Journal of Rural and Tropical Public Health, 10, 48-52.
[20] Adedimeji, A., Abboud, N., Merdekios, B. and Shiferaw, M. (2012) A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia. International Journal of Population Research, 2012, 7.
[21] Sebert Kuhlmann, A.K., Kraft, J.M., Galavotti, C., Creek, T.L., Mooki, M. and Ntumy, R. (2008) Radio Role Models for the Prevention of Mother-to-Child Transmission of HIV and HIV Testing among Pregnant Women in Botswana. Health Promotion International, 23, 260-268.
[22] Lovell, C.C., Pappas-DeLuca, K.A., Sebert Kuhlmann, A.K., Koppenhaver, T., Kong, S., Mooki, M. and Galavotti, C. (2007) “One Day I Might Find Myself HIV-Positive like Her”: Audience Involvement and Identification with Role Models in an Entertainment-Education Radio Drama in Botswana. International Quarterly of Community Health Education, 28, 181-200.
[23] Houston, E., McKirnan, D.J., Cervone, D., Johnson, M.S. and Sandfort, T.G.M. (2011) Assessing Treatment Motivation among Patients Receiving Antiretroviral Therapy: A Multidimensional Approach. Psychology & Health, 27, 674-687.
[24] Holstad, M.M., DiIorio, C. and Magowe, M.K. (2006) Motivating HIV Positive Women to Adhere to Antiretroviral Therapy and Risk Reduction Behavior: The KHARMA Project. The Online Journal of Issues in Nursing, 11, 5.
[25] World Health Organization (2014) Health Systems.
[26] Sprague, C., Chersich, M.F. and Black, V. (2011) Health System Weaknesses Constrain Access to PMTCT and Maternal HIV Services in South Africa: A Qualitative Enquiry. AIDS Research and Therapy, 8, 10.
[27] Khan, H. (2007) From Mother to Mother: A Peer Mentor Program to Prevent Mother-to-Child Transmission of HIV in South Africa Offers Much Needed Support.
[28] Nsagha, D.S., Halle-Ekane, G.E., Nfor, C.S., Ngowe, M.N. and Nasah, B.T. (2014) The Role of the Male Partner in the Prevention of Mother to Child Transmission of HIV in Cameroon. American Journal of Epidemiology and Infectious Disease, 2, 52-59.
[29] Kalembo, F.W., Zgambo, M., Mulaga, A.N., Yukai, D. and Ahmed, N.I. (2013) Association between Male Partner Involvement and the Uptake of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Interventions in Mwanza District, Malawi: A Retrospective Cohort Study. PLoS ONE, 8, e66517.
[30] Knodel, J., Kespichayawattana, J., Saengtienchai, C. and Wiwatwanich, S. (2010) The Role of Parents and Family Members in ART Treatment Adherence: Evidence from Thailand. Research on Aging, 32, 19-39.
[31] Binagwaho, A. and Ratnayake, N. (2009) The Role of Social Capital in Successful Adherence to Antiretroviral Therapy in Africa. PLoS Medicine, 6, e18.
[32] O’Laughlin, K.N., Wyatt, M.A., Kaaya, S., Bangsberg, D.R. and Ware, N.C. (2012) How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention. AIDS and Behavior, 16, 1308-1315.
[33] Campbell, C., Skovdal, M. and Gibbs, A. (2011) Creating Social Spaces to Tackle AIDS-Related Stigma: Reviewing the Role of Church Groups in Sub-Saharan Africa. AIDS and Behavior, 15, 1204-1219.
[34] Keikelame, M.J., Murphy, C.K., Ringheim, K.E. and Woldehanna, S. (2010) Perceptions of HIV/AIDS Leaders about Faith-Based Organizations’ Influence on HIV/AIDS Stigma in South Africa. African Journal of AIDS Research, 9, 63-70.
[35] van Nes, F., Abma, T., Jonsson, H. and Deeg, D. (2010) Language Differences in Qualitative Research: Is Meaning Lost in Translation? European Journal of Ageing, 7, 313-316.
[36] Hardon, A, Vernooij, E., Bongololo-Mbera, G., Cherutich, P., Desclaux, A., Kyaddondo, D., et al. (2012) Women’s Views on Consent, Counseling and Confidentiality in PMTCT: A Mixed-Methods Study in Four African Countries. BMC Public Health, 12, 26.
[37] Nederhof, A. (1985) Methods of Coping with Social Desirability Bias: A Review. European Journal of Social Psychology, 15, 263-280.
[38] Wiegert, K., Dinh, T.H., Mushavi, A., Mugurungi, O. and Kilmarx, P.H. (2014) Integration of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Postpartum Services with Other HIV Care and Treatment Services within the Maternal and Child Health Setting in Zimbabwe, 2012. PLoS ONE, 9, e98236.
[39] Mnyani, C.N. and McIntyre, J. (2013) Challenges to Delivering Quality Care in a Prevention of Mother-to-Child Transmission of HIV Programme in Soweto, South Africa. Southern African Journal of HIV Medicine, 14.
[40] Rothman, K.J. (2002) Epidemiology: An Introduction. Oxford University Press, New York.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.