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
Open accessAbstract
Objectives: To investigate and synthesize reasons for low access, initiation and adherence to antiretroviral drugs by mothers and exposed babies for prevention of mother‐to‐child transmission (PMTCT) of HIV in sub‐Saharan Africa. Methods: A systematic literature review was conducted. Four databases were searched (Medline, Embase, Global Health and Web of Science) for studies conducted in sub‐Saharan Africa from January 2000 to September 2012. Quantitative and qualitative studies were included that met pre‐defined criteria. Antiretroviral (ARV) prophylaxis (maternal/infant) and combination antiretroviral therapy (ART) usage/registration at HIV care and treatment during pregnancy were included as outcomes. Results: Of 574 references identified, 40 met the inclusion criteria. Four references were added after searching reference lists of included articles. Twenty studies were quantitative, 16 were qualitative and eight were mixed methods. Forty‐one studies were conducted in Southern and East Africa, two in West Africa, none in Central Africa and one was multi‐regional. The majority ( n =25) were conducted before combination ART for PMTCT was emphasized in 2006. At the individual‐level, poor knowledge of HIV/ART/vertical transmission, lower maternal educational level and psychological issues following HIV diagnosis were the key barriers identified. Stigma and fear of status disclosure to partners, family or community members (community‐level factors) were the most frequently cited barriers overall and across time. The extent of partner/community support was another major factor impeding or facilitating the uptake of PMTCT ARVs, while cultural traditions including preferences for traditional healers and birth attendants were also common. Key health‐systems issues included poor staff‐client interactions, staff shortages, service accessibility and non‐facility deliveries. Conclusions: Long‐standing health‐systems issues (such as staffing and service accessibility) and community‐level factors (particularly stigma, fear of disclosure and lack of partner support) have not changed over time and continue to plague PMTCT programmes more than 10 years after their introduction. The potential of PMTCT programmes to virtually eliminate vertical transmission of HIV will remain elusive unless these barriers are tackled. The prominence of community‐level factors in this review points to the importance of community‐driven approaches to improve uptake of PMTCT interventions, although packages of solutions addressing barriers at different levels will be important.
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Barriers to PMTCT service uptake and retention include lack of coordinated and continuous care for HIV-positive mother-baby pairs.
“Barriers to PMTCT service uptake and retention include lack of coordinated and continuous care for HIV-positive mother-baby pairs [10-12]”
Health system challenges to implementing Option B+ include health facility resource limitations such as shortage of staff and drugs.
“There are also multiple health system challenges to implementing Option B+. The most common among them are health facility resource limitations such as shortage of staff and drugs [10,20,21].”
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- [80]Gourlay A Mshana GH Wringe A Urassa M Mkwashapi D Birdthistle I Barriers to the uptake of prevention of mother-to-child transmission HIV services in rural Tanzania: a qualitative study. Global Maternal Health Conference 2013 1 08 Arusha Maternal Health Task Force
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- Authors
- Gourlay, A., Birdthistle, I., Mburu, G., Iorpenda, K., & Wringe, A.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- International HIV/AIDS Alliance (GB)
- Corresponding author
- Gourlay, Annabelle
- Venue
- Journal of the International AIDS Society
- Publisher
- Wiley
- Published
- 2013-01
- Volume
- 16
- Issue
- 1
- Pages
- 18588-18588
- ISSN
- 1758-2652 (ISSN-L)
- PMC
- PMC3717402
- OpenAlex
- W2125602043
- Cited by
- 399
- References
- 81
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 18 · 2023: 17 · 2022: 23 · 2021: 40 · 2020: 31 · 2019: 38 · 2018: 52 · 2017: 39 · 2016: 53 · 2015: 41 · 2014: 22 · 2013: 5
- FWCI
- 5.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of the International AIDS Society (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lancaster EPrints (Lancaster University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Sweden/Norad
- Africa Regional Programme
- International HIV/AIDS Alliance
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- prevention of mother-to-child transmission of HIV, antiretroviral drugs, antiretroviral therapy adherence, antiretroviral prophylaxis, highly active antiretroviral therapy, HIV stigma, partner support, community support, traditional healers, health system barriers, maternal education, sub-Saharan Africa
- MeSH terms
- Female, Health Services Accessibility, Humans, Patient Compliance, Pregnancy, HIV Infections, Africa South of the Sahara, Infectious Disease Transmission, Vertical, Chemoprevention, Anti-HIV Agents, Anti-Retroviral Agents
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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