The Botswana Harvard AIDS Institute Partnership for HIV Research and Education: Press Release

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Health and Social Consideration of HIV Positive Women Participating in a PMTCT Clinical Trial in Rural Botswana

Authors: Magnhild Eide, Marte Myhre, Peter Arimi, Mochudi site Mashi team, Morten Linbaek, Johanne Sundby, Carolyn Wester, Lisa Stocking, Ibou Thior, Max Essex

Institute of community medicine, University of Oslo, Oslo Norway, in collaboration with Botswana-Harvard AIDS Institute Partnership, Gaborone Botswana
(Track* A5 and B8)

Background
Botswana-Harvard AIDS Institute Partnership is conducting a randomised clinical trial with a 2x2 factorial design to evaluate the optimal approaches to PMTCT among a previously predominantly breastfeeding population. Infants from HIV infected mothers are randomised to either a formula feeding arm with one month of ZDV prophylaxis or a breastfeeding arm with six months of ZDV prophylaxis. All women received at least the standard of care for PMTCT in Botswana, which include short course ZDV starting 34 weeks in pregnancy till delivery and one month prophylaxis to the infant. We assessed components of the trial which participating women considered as positive or negative and the amount of support they received from their families.

Method
Between December 2001 and January 2002, a sample of 52 women was randomly selected amongst participants at Mochudi study clinic. Interviews were conducted over a four week-period using a structured questionnaire.

Results:

Positive N=52

Access to Doctor 49 (94%)

Support from Health staff 50 (96%)

Attitude of Health staff 48 (92%)

Access to more laboratory evaluations 46 (88%)

Quality of information 47 (90%)

Confidentiality 44 (85%)

Efficiency of staff 40 (77%)

Negative N=52

Home visit 46 (88%)

Randomisation 45 (86%)

Support N=22 (42%)
Had disclosed their status

Sexual Partner 17 (77%)

Mother 20 (91%)

Sister 16 (73%)

Conclusions
Access to a better quality of care was the main positive aspect identified by clinical trial participants. For the 15% who thought confidentiality was not maintained, home visit by study staff was the main reason. Randomisation to infant feeding may have conflicted with the method expected at the participants home. For those who disclosed their status, the support from their families to participate was high. Strategies to assist women in disclosing their HIV status to their families could have a positive impact overall on PMTCT program uptake.