For many women, antenatal clinics (ANC) are their first touchpoint with the health system. Here, they are tested, counseled, and started on lifesaving ARVs under the PMTCT (Prevention of Mother-to-Child Transmission) program.
But something happens after birth.
Dropout rates skyrocket.
Follow-ups decline.
Adherence falters.
Mothers miss their review appointments.
Babies are not brought for early infant diagnosis.
And vertical transmission happens—especially during breastfeeding, which carries a significant risk if the mother’s viral load isn’t suppressed.
Why Women Discontinue ARVs Postpartum:
- Stigma & Silence
Many women don’t disclose their status to their partners or family. After delivery, they return to households that don’t support medication use. - Overwhelmed by New Motherhood
Fatigue, stress, and emotional instability after delivery can cause women to deprioritize medication. - Lack of Integrated Care
Many facilities separate maternal child health and HIV clinics—forcing women to visit multiple service points, which is inconvenient and demotivating. - Poor Counselling & Follow-Up
Some health workers focus only on pregnancy but fail to emphasize the importance of lifelong ART for maternal health and child protection. - Partner Influence or Intimate Partner Violence (IPV)
In some households, partners control a woman’s access to health services or punish them for attending HIV clinics. - Economic & Transportation Barriers
Some women can’t afford transport to clinics—especially after delivery when income is tight.
What Can We Do as a Country?
1. Integrate HIV and Maternal-Child Health Services
Offer one-stop clinics for PMTCT, child immunization, ART refills, and postpartum checkups to make it easier for mothers to adhere.
2. Strengthen Postpartum Follow-Up Systems
Create community-based support systems—use community health volunteers (CHVs) to follow up on postpartum women at home, especially in rural and informal settlements.
3. Expand the Use of Digital Tools
Use SMS reminders, call follow-ups, and mobile apps to support adherence, like the successful cStock and mHealth initiatives in Kenya.
4. Promote Male Involvement
HIV should not be a “women’s issue.” Encourage partner testing and shared responsibility during ANC visits and postnatal care.
5. Address Stigma in Health Facilities
Train healthcare workers to offer non-judgmental, confidential care to women living with HIV—especially those who default.
6. Provide Mental Health Support
Integrate mental health screening and counseling into PMTCT programs. Depression and anxiety are common postpartum and can affect adherence.
7. Offer Peer Support Groups for HIV+ Mothers
Support groups (like “Mentor Mothers”) provide emotional support and shared experiences, which significantly improve retention and adherence.
Conclusion
We can eliminate vertical transmission in Kenya.
But only if we support women beyond pregnancy.
Let’s empower them with knowledge, tools, support systems, and dignity—so that no baby is born or breastfed into HIV, and no mother dies from preventable complications.
Because adherence is not just a pill a day—it’s a lifeline.
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