Barriers and facilitating factors to the uptake of antiretroviral drugs for PMTCT of HIV in sub-Saharan Africa: A systematic review

Annabelle Gourlay, Isolde Birdthistle, Gitau Mburu, Kate Iorpenda, Alison Wringe. Journal of the International AIDS Society 2013, 2013; 16:18588 Download publication (open access)

This paper synthesizes the reasons for low levels of access, initiation and adherence to prevention of mother-to-child transmission (PMTCT) interventions in sub-Saharan Africa.

The review illustrates the significance of structural barriers for the effectiveness of biomedical interventions, particularly the role of stigma in preventing access to preventive treatment for HIV. The findings show that:

  • poor knowledge of HIV risk and treatment, lower maternal educational level and psychological issues following HIV diagnosis were key barriers to women’s uptake of PMTCT ARVs
  • stigma and fear of disclosing status to partners, family or community members (community-level factors) were the most frequently cited barriers overall and across time
  • key health-systems issues included poor staff-client interactions, staff shortages, service accessibility and non-facility deliveries;
  • the extent of partner/community support was another major factor impeding or facilitating the uptake of PMTCT ARVs
  • cultural traditions including preferences for traditional healers and birth attendants were also influential

The article concludes that the potential of PMTCT programmes to virtually eliminate vertical transmission of HIV will remain elusive unless these barriers are tackled. 


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