Prevention of Mother-to-Child Transmission (PMTCT) Adherence Barriers of Pregnant Women and New Mothers Living with HIV in Greater Gaborone, Botswana

Abstract

<title>Abstract</title> In 2021 Botswana was certified with a silver-tiered status by the World Health Organization, as it reduced mother-to-child HIV transmission to under 5%, provided antenatal care and antiretroviral therapy (ART) to over 90% of pregnant women, and attained a HIV case rate of less than 500 cases per 100,000 live births. This study aims to assist Botswana in obtaining gold-tier status by providing insights into stressors associated with new motherhood for women living with HIV and how these stressors contribute to Prevention of Mother-to-Child Transmission (PMTCT) non-adherence in Greater Gaborone. A mixed-methods approach included surveying a sample of pregnant women (n = 14) and new mothers (n = 53) attending 21 ART clinics. Cox proportional hazard models examined the hypothesis “with increasing time diagnosis to ART exposure, the likelihood of PMTCT non-adherence will increase” particularly for women experiencing individual stressors exacerbated by extreme heat and water rationing. Content analysis was used to interpret qualitative findings. Results show that a majority of pregnant women and new mothers had partners who were also HIV+ (n = 45) and some women did not disclose (n = 12) or were unsure if their partner (n = 10) knew of their HIV status. For mothers who were unemployed and dependent upon their partner for economic security, extreme heat and water rationing were barriers to personal care and psychological well-being. Public health messaging that helps pregnant women and new mothers communicate the sensitive topic of HIV with their partner is needed, and clinics should ensure water availability to promote clinic attendance and PMTCT adherence.