Integrating Mother and Child Influences into the Multilevel Factors Impacting Women's HIV Care Continuum Outcomes Öffentlichkeit

Abstract

Background: In spite of recent declines in HIV rates among African American women, the burden is still skewed towards African American and Hispanic women between the ages of 15-39, especially in the southern United States.

Objective: The study aims to examine how maternal factors differ across defined care continuum groups and how multilevel interactions and contexts condition care engagement and adherence among women living with HIV.

Methods: We recruited 33 participants (96% African American, 4% other races) who were female by birth and between the ages of 25-60 years from the Atlanta WIHS for one-on-one in-depth interviews. Themes were evaluated using the Bronfenbrenner Socioecological Model and Berkman Model of Social Networks. Specifically, emergent themes were embedded into these two models in order to develop pathways by which care outcomes may vary by care group.

Results: Involvement of children with HIV care varied across care groups and influenced access to and maintenance of care. Pregnancy played a significant role in diagnosis and care engagement across all care groups. Care engaged women seemed to have a higher perception of and access to care that optimized their safety and the safety of their neonate. However, care detached women reported receiving care during pregnancy in a manner that suggests disengagement from the decision. In addition, reproductive counseling and referral contributed to women leaving care after diagnosis and never initiating care. Timing of appointments and flexibility of the health care provider to accommodate other obligations (particularly those related to maternal duties) played a large role in retention in care. Although most of the care inconsistent and care detached women had a good outlook on life and some self-motivation, this did not translate to better care outcomes.

Conclusion: Social interactions are an important component in the health of WLWH, especially among those of childbearing age. The results elicit the need for integration of reproductive and maternal needs into HIV care and treatment and the need to investigate the impact of child outcomes on post-partum retention in care. Further investigation is warranted among pregnant women to gain a deeper understanding of culturally appropriate methods of reproductive counseling.

Table of Contents

Chapter 1: Introduction………………………………………………………………..1

Study Purpose……………………………………………………............................5

Research Questions……………………………………………………………...........6

Chapter 2: Literature Review………………………………………………………....7

Theoretical Model……………………………………………………………………….8

Figure 1: Bronfrenbrenner Model of HIV Care Outcomes……...……………..10

Health Issues of Women Living with HIV (WLWH)……………………………..10

Previous Interventions………………………………………………………………..19

Theory and Justifications for Qualitative Study………………………………....20

Chapter 3: Methods…………………………………………………………………....22

Research Design………………………………………………………………………...22

Population and Sample……………………………………………………………..…22

Instruments and Procedures……………………………………………………….…23

Transcript Coding and Analysis………………………………………………………27

Chapter 4: Results……………………………………………………………………….29

Overview of Qualitative Findings…………………………………………………….29

Table 1: Influence of housing on care……………………………………………….30

Table 2: Influence of reproductive counseling on care…………………………..31

Table 3: Influence of hospital staff on care………………………………………...32

Table 4: Influence of flexibility of staff on care...………………………..……….33

Table 5: Hours/Process for medical care…………………………………………….34

Table 6: Influence of the involvement of children on care………...……………36

Table 7: Influence of Motherhood on care…………………………………………..37

Table 8: Fear of HIV affecting maternal roles……………...…………………..….38

Table 9: Child-care support system…...………………………………………….....39

Table 10: Mental Health………………………………………………………………...40

Table 11: Influence of Self-Motivation on care…………………………………….41

Table 12: Outlook on Life……………………………...……………………………….42

Table 13: Guilt of HIV Status…………………………………...……………………..43

Chapter 5: Discussion……………………………………………………………………44

Findings………………...……………………………………………………………….....44

Theoretical Framework ………………………………………………………………….49

Figure 2: A conceptualization of the combined Berkman-Bronfrenbrenner Model on HIV

Care Outcomes among WLWH………………...……………………………………….49

Strengths…………………………………………………………………………………...50

Limitations………………………………………………………………………………...50

Chapter 6: Implications and Recommendations…………………………………..51

Conclusion ……………………………………………………………………………......51

Recommendations ……………………………………………………………………….51

References………………………………………………………………………………….54

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	Berkman model of social networks HIV Care Continuum Outcomes Post-partum retention in care Maternal and Child Health Bronfenbrenner Socioecological Model Social interactions
Committee Chair / Thesis Advisor	Frew, Paula, Emory University
Committee Members	Randall, Laura A, Emory University

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