Why do HIV-positive pregnant women discontinue with comprehensive PMTCT services - A qualitative study

Background and purpose: Prevention of mother to child transmission (PMTCT) is a government program aimed at preventing mother-to-child transmission of HIV. A comprehensive PMTCT program involves the implementation of HIV testing up to antiretroviral (ARV) treatment for mothers with positive HIV test results. Coverage of comprehensive PMTCT remains low, with many HIV-positive pregnant women who discontinued ARV treatment. This study aims to explore the reasons of HIV-positive pregnant women to discontinue with the comprehensive PMTCT program. Methods: A qualitative study was carried out in Badung District, Bali Province, with seven respondents: one HIV-positive pregnant woman who did not continue the ARV treatment, two HIV-positive women who gave birth the previous year and did not take ARV, three public health centre (PHC) providers, and one head of PHC. Respondents were selected using a purposive sampling technique. Data were collected through in-depth interviews and analyzed thematically. The results presented narratively to illustrate the reasons why HIV-positive pregnant women discontinued with the comprehensive PMTCT program. Results: The emerging themes related to the reasons of HIVpositive pregnant women discontinued with the comprehensive PMTCT program included the lack of comprehensive PMTCT-related information, the lack of health provider assistance, and the high stigma towards people living with HIV (PLHIV). These barriers were affecting the willingness of HIV-positive pregnant women to continue with the program. Conclusions: Lack of comprehensive PMTCT-related information, lack of assistance by health care providers, and high public stigma impacts upon HIV-positive pregnant women’s willingness to continue with comprehensive PMTCT program. There is a need for a minimum service standard in the implementation of comprehensive PMTCT services and comprehensive information on HIV infection in order to reduce the stigma towards PLHIV.