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Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment

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Abstract

HIV-positive pregnant women who are initiated on lifelong antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) have lower adherence rates after delivery. We quantified maternal motivation to take preventive therapy before and after delivery among pregnant women newly diagnosed with HIV. We enrolled pregnant women (≥ 18 years) with a recent HIV diagnosis (< 6 months) at 14 public primary health clinics in Matlosana, South Africa and followed them in the postpartum period. Participants received eight choice tasks comparing two mutually exclusive sub-sets of seven possible benefits related to preventive therapy identified through literature reviews and key informant interviews. Data was analyzed using conditional logit regression in the antepartum versus postpartum periods. Coefficients are reported with 95% confidence intervals (CI). Sixty-five women completed surveys both at enrollment and in the postpartum period. All women were already on ART, while 21 (32%) were receiving IPT at enrollment. The mean CD4 count was 436 (± 246) cells/mm3. In the antepartum period, preventing HIV transmission to partners was the most important benefit (coefficients (ß) = 0.87, 95% CI 0.64, 1.11), followed by keeping healthy for family (ß = 0.75, 95% CI 0.52, 0.97). Such prioritization significantly decreased in the postpartum period (p < 0.001). Compared to other motivators, keeping a high CD4 count was least prioritized in the antepartum period (ß = 0.19, 95% CI − 0.04, 0.43) but was most prioritized in the postpartum period (ß = 0.39, 95% CI 0.21, 0.57). These results highlight that messages on family might be particularly salient in the antepartum period, and keeping CD4 count high in the postpartum period. Understanding maternal motivation may help to design targeted health promotion messages to HIV-positive women around the time of delivery.

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Acknowledgements

We thank all study participants for devoting their time to take part in this study. We thank our study coordinators, Sandy Chon, Cokiswa Quomfo, Juanita Market, Mmabatho Malegotsia, Elvis Rangxa, Thembekile Mmmoledi as well as all study staff who helped in data collection.

Funding

This study was funded by NIH supplement R01AI095014 02S1.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA

    Hae-Young Kim, David W. Dowdy, Jonathan Golub & Colleen F. Hanrahan

  2. Africa Health Research Institute, Kwazulu-Natal, South Africa

    Hae-Young Kim

  3. School of Nursing and Public Health, University of KwaZulu-Natal, Kwazulu-Natal, South Africa

    Hae-Young Kim

  4. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    David W. Dowdy, Deanna Kerrigan, Jonathan Golub & John F. P. Bridges

  5. Perinatal HIV Research Unit, University of Witwatersrand, Johannesburg, South Africa

    Neil A. Martinson

  6. Center for Tuberculosis Research, Johns Hopkins University, Baltimore, MD, USA

    Neil A. Martinson & Jonathan Golub

  7. Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Deanna Kerrigan & John F. P. Bridges

  8. International Council of Nurses, Geneva, Switzerland

    Carrie Tudor

  9. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    John F. P. Bridges

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  1. Hae-Young Kim
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Contributions

All authors contributed to design the study. H-YK, CFH, and NM helped to collect the data. H-YK and JFPB performed the data analysis. DK and CT conducted the qualitative interviews. HYK wrote the initial draft of the paper. All authors contributed to read and revised the final manuscript.

Corresponding author

Correspondence to Colleen F. Hanrahan.

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The authors declared that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kim, HY., Dowdy, D.W., Martinson, N.A. et al. Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment. AIDS Behav 23, 1689–1697 (2019). https://doi.org/10.1007/s10461-018-2324-x

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