{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T07:10:58Z","timestamp":1794035458844,"version":"4.8.0"},"reference-count":92,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,7,19]],"date-time":"2013-07-19T00:00:00Z","timestamp":1374192000000},"content-version":"vor","delay-in-days":199,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"name":"Sweden\/Norad"},{"name":"Africa Regional Programme"},{"name":"International HIV\/AIDS Alliance","id":[{"id":"https:\/\/ror.org\/01xjydw85","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate and synthesize reasons for low access, initiation and adherence to antiretroviral drugs by mothers and exposed babies for prevention of mother\u2010to\u2010child transmission (PMTCT) of HIV in sub\u2010Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature review was conducted. Four databases were searched (Medline, Embase, Global Health and Web of Science) for studies conducted in sub\u2010Saharan Africa from January 2000 to September 2012. Quantitative and qualitative studies were included that met pre\u2010defined criteria. Antiretroviral (ARV) prophylaxis (maternal\/infant) and combination antiretroviral therapy (ART) usage\/registration at HIV care and treatment during pregnancy were included as outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 574 references identified, 40 met the inclusion criteria. Four references were added after searching reference lists of included articles. Twenty studies were quantitative, 16 were qualitative and eight were mixed methods. Forty\u2010one studies were conducted in Southern and East Africa, two in West Africa, none in Central Africa and one was multi\u2010regional. The majority (\n                      <jats:italic>n<\/jats:italic>\n                      =25) were conducted before combination ART for PMTCT was emphasized in 2006. At the individual\u2010level, poor knowledge of HIV\/ART\/vertical transmission, lower maternal educational level and psychological issues following HIV diagnosis were the key barriers identified. Stigma and fear of status disclosure to partners, family or community members (community\u2010level factors) were the most frequently cited barriers overall and across time. The extent of partner\/community support was another major factor impeding or facilitating the uptake of PMTCT ARVs, while cultural traditions including preferences for traditional healers and birth attendants were also common. Key health\u2010systems issues included poor staff\u2010client interactions, staff shortages, service accessibility and non\u2010facility deliveries.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long\u2010standing health\u2010systems issues (such as staffing and service accessibility) and community\u2010level factors (particularly stigma, fear of disclosure and lack of partner support) have not changed over time and continue to plague PMTCT programmes more than 10 years after their introduction. The potential of PMTCT programmes to virtually eliminate vertical transmission of HIV will remain elusive unless these barriers are tackled. The prominence of community\u2010level factors in this review points to the importance of community\u2010driven approaches to improve uptake of PMTCT interventions, although packages of solutions addressing barriers at different levels will be important.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7448\/ias.16.1.18588","type":"journal-article","created":{"date-parts":[[2013,7,19]],"date-time":"2013-07-19T10:25:42Z","timestamp":1374229542000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":323,"title":["Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother\u2010to\u2010child transmission of HIV in sub\u2010Saharan Africa: a systematic review"],"prefix":"10.1002","volume":"16","author":[{"given":"Annabelle","family":"Gourlay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isolde","family":"Birdthistle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitau","family":"Mburu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Iorpenda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison","family":"Wringe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,7,19]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Towards universal access: scaling up priority HIV\/AIDS interventions in the health sector","author":"World Health Organisation","year":"2010"},{"key":"e_1_2_9_3_1","volume-title":"Global report: UNAIDS report on the global AIDS epidemic 2012","author":"United Nations","year":"2012"},{"key":"e_1_2_9_4_1","volume-title":"PMTCT strategic vision 2010\u20132015: preventing mother\u2010to\u2010child transmission of HIV to reach the UNGASS and millennium development goals","author":"World Health Organisation","year":"2010"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31827e4992"},{"key":"e_1_2_9_6_1","volume-title":"Programmatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants","author":"World Health Organisation","year":"2012"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62303-3"},{"key":"e_1_2_9_8_1","volume-title":"New data on the prevention of mother\u2010to\u2010child transmission of HIV and their policy implications","author":"World Health Organisation","year":"2001"},{"key":"e_1_2_9_9_1","volume-title":"Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access","author":"World Health Organisation","year":"2006"},{"key":"e_1_2_9_10_1","volume-title":"Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants","author":"World Health Organisation","year":"2004"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0030438"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02091.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328359590f"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e328359ab0c"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2012.02958.x"},{"issue":"2","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"17373","DOI":"10.7448\/IAS.15.4.17373","article-title":"Community\u2010based approaches for prevention of mother to child transmission in resource\u2010poor settings: a social ecological review","volume":"15","author":"Busza J","year":"2012","journal-title":"J Int AIDS Soc"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.05.034"},{"key":"e_1_2_9_18_1","volume-title":"Global plan towards the elimination of new infections and keeping mothers alive: 2011\u20132015","author":"Joint United Nations Programme on HIV\/AIDS","year":"2011"},{"key":"e_1_2_9_19_1","unstructured":"United Nations.Millennium development goals [Internet]. 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