Interactions among poverty, gender, and health systems affect women's participation in services to prevent HIV transmission from mother to child: A causal loop analysis

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  • Yourkavitch, Jennifer
    • Affiliation: Carolina Population Center
  • Lich, Kristen Hassmiller
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Flax, Valerie
    • Affiliation: Carolina Population Center
  • Okello, Elialilia S.
    • Other Affiliation: Makerere University
  • Kadzandira, John
    • Other Affiliation: University of Malawi
  • Katahoire, Anne Ruhweza
    • Other Affiliation: Makerere University
  • Munthali, Alister C.
    • Other Affiliation: University of Malawi
  • Thomas, James C.
    • Affiliation: Carolina Population Center
Abstract
  • Retention in care remains an important issue for prevention of mother-to-child transmission (PMTCT) programs according to WHO guidelines, formerly called the ªOption B+º approach. The objective of this study was to examine how poverty, gender, and health system factors interact to influence women's participation in PMTCT services. We used qualitative research, literature, and hypothesized variable connections to diagram causes and effects in causal loop models. We found that many factors, including antiretroviral therapy (ART) use, service design and quality, stigma, disclosure, spouse/partner influence, decision- making autonomy, and knowledge about PMTCT, influence psychosocial health, which in turn affects women's participation in PMTCT services. Thus, interventions to improve psychosocial health need to address many factors to be successful. We also found that the design of PMTCT services, a modifiable factor, is important because it affects several other factors. We identified 66 feedback loops that may contribute to policy resistanceÐthat is, a policy's failure to have its intended effect. Our findings point to the need for a multipronged intervention to encourage women's continued participation in PMTCT services and for longitudinal research to quantify and test our causal loop model.
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  • Article
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  • In Copyright
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  • Attribution 3.0 United States
Journal title
  • PLoS ONE
Journal volume
  • 13
Journal issue
  • 5
Language
  • English
ISSN
  • 1932-6203

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