UC Berkeley

Despite the availability of highly efficacious antiretroviral drug regimens for the prevention of mother-to-child HIV transmission (PMTCT), transmission rates remain higher than those achieved in clinical trials. Access to these efficacious drug regimens continues to expand rapidly in countries most affected by HIV. Such expansion is an important first step in dramatically reducing mother-to-child HIV transmission rates. However, beyond access to drug regimens, programs must also identify and address individual and structural factors impeding the utilization of and adherence to PMTCT services by the women they are designed to serve. Additional research into factors both positively or negatively associated with PMTCT service utilization could help improve PMTCT programs to further reduce transmission rates.

Each of the three papers included in this dissertation examined different factors of PMTCT service utilization. The first two papers analyze secondary data from a large-scale impact evaluation of Zimbabwe’s PMTCT program. Specifically, the first paper explores the association between costs (service costs, travel time, and transportation costs) and utilization of all recommended PMTCT services. The second paper explores the relationship between the timing of a pregnant woman’s HIV-positive diagnosis, either prior to pregnancy or during antenatal care, and her utilization of PMTCT services. The hypotheses was that women who were diagnosed prior to pregnancy, having had more time to cope with their diagnosis, would complete more of the recommended PMTCT services. The final paper utilizes policy analysis methodology to examine two different implementation strategies Malawi could consider to improve lifelong adherence to antiretroviral therapy (ART) among women living with HIV who initiate treatment during pregnancy or breastfeeding. The two strategies proposed were: 1) for all pregnant/breastfeeding women to initiate and indefinitely receive treatment at maternal and child health clinics rather than be transferred to an ART specialty clinic, and 2) to expand access to lifelong ART, regardless of stage of disease, to any individual living with HIV in the pregnant/breastfeeding woman’s household.