Implications for the uptake of HIV and TB preventive therapies among HIV-positive pregnant women in South Africa
Kim, Hae Young
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Of 33 million people living with HIV worldwide in 2015, one-third are estimated to be infected with Mycobacterium tuberculosis. About 1.2 million new cases of tuberculosis (TB) occurred among people living with HIV (PLWH), which account 11% of all TB incidence cases. HIV-positive pregnant women are a particularly relevant population for delivering preventive therapies for HIV and TB. In South Africa, over 30% of women who came to public antenatal clinics were HIV-positive in 2013. Active tuberculosis during pregnancy increases not only the risk of maternal mortality but also infant adverse health outcomes. Isoniazid preventive therapy (IPT) can reduce the risk of developing TB up to 60% among PLWH. Thus to ensure better health outcomes for both infants and mothers, antiretroviral therapy (ART) for life-long period and IPT for at least 12 months are recommended to all HIV-positive pregnant women. However, the uptake of IPT has been slow around the world and retention in care and adherence rates significantly drop once delivery occurs. This thesis addresses the gaps in understanding patients’ priorities and motivations to take preventive therapies in HIV-positive pregnant women. In a prospective cohort of 204 pregnant women recently diagnosed with HIV in Matlosana, South Africa, maternal priorities and motivation to take preventive therapies for HIV and TB were examined during the antepartum and postpartum periods using stated preference methods. Factors at individual, interpersonal or health services levels and potential motivators that may influence patients’ decisions to take preventive therapies were selected based on qualitative interviews and literature reviews. We also explored the cost-effectiveness of providing IPT to all eligible HIV-positive pregnant women without LTBI screening strategies. Our findings suggest that women prioritize infants’ health and concern for partners and family and may make medical decisions around these factors but also have high perceived benefits of medications for their own health. Universal IPT could be considered cost-effective compared to test-driven strategies. Incorporating these findings would be important to develop patient-centered interventions for enhancing the uptake of ART and IPT among HIV-positive pregnant women in South Africa and other similar settings with high TB and HIV burden.