Despite availability of free HIV care in many low- and middle-income countries, fewer women living with HIV (WLHIV) remain in care in thefirst year after childbirththan during怀孕。WLHIV who do not stay in care do not receive antiretroviral therapy and are at increased通过艾滋病毒的风险to their child or partner and may also experienceworse与HIV相关的健康结果。UNAIDS estimate加纳，大约有五分之一的艾滋病毒暴露儿童通过停止母乳喂养而感染了艾滋病毒。这种母亲到孩子传播的速度（MTCT）是西非第二高的，也是21个焦点国家中第四高的UNAIDS tracks。

在产后，艾滋病毒护理率的辍学率比怀孕期间高的原因尚不清楚。研究人员提出了几种理论：由于与医疗保健系统的预定相遇较少，由于MTCT后分娩后的感知易感性下降，因此妇女可能会失业。优先级of their child’s health over their own, or due to challenges with childcare — but there is little evidence to support any one of these theories over the others.

为了更好地理解这个问题，我们对加纳的三十个产后WLHIV进行了定性访谈，该采访于2016年从城市阿克拉城市的两家三级医院招募。我们的新文章在BMC Pregnancy and Childbirth介绍妇女本身描述的障碍。

多个障碍

Women’s accounts suggest that social, economic, and physical health factors, more than a change in individual motivation, may explain why fewer women remain in HIV care in the postpartum year than during pregnancy. Broadly, we found that the social and economic costs of staying in HIV care became higher in the postpartum year and many who dropped out experienced multiple barriers.

Ghana has the potential to eliminate MTCT of HIV; doing so will require a concerted and deliberate effort to support postpartum WLHIV to stay in HIV care.

与艺术相关的副作用和HIV否认是怀孕期间最强的障碍，对重新体验艺术作用的恐惧，即使在分娩后，也继续使母亲远离艾滋病毒护理。一位参与者分享了她的故事：

在怀孕期间，由于副作用，我服用药物时遭受了痛苦。因此，每当我想到（出生后）回去吃毒品时，副作用的想法就会想到我，并困扰着我。我变得害怕。

The challenge of travel and transport

One unique barrier in the early postpartum months was difficulty traveling to HIV care due to complications from childbirth or prolonged recovery from a cesarean section. For example, one mother remarked:

大多数母亲会告诉您，头六个月非常艰难。自从某些人进行手术以来，许多妇女会花时间努力工作[即剖腹产]。其他人也有阴道的眼泪，因此他们可能需要一些时间来照顾自己。母亲需要六个月或更长时间才能在分娩后恢复正常的生活[即健康并参观艾滋病毒治疗中心以进行护理]。有些人也是单身母亲，他们在家中没有支持。

Relatedly, for a few of the women who had dropped out of care, childbirth was associated with debt, unemployment, or underemployment. This led to a new reliance on others, such as a partner or relative, to give them money before they could make their HIV care visits, even when their motivation to stay in HIV care was high.

运输方式是最重要的障碍，对产后特有的新社会文化压力面临的母亲的成本增加。产后母亲有动力保护孩子的健康trotro,which they typically took during pregnancy. Taxis could protect their children from the risk of illness and excessive heat common to the hot and crowdedtrotros,but they were more expensive, costing one participant 70% of her monthly salary.

艾滋病病毒stigma also contributed to high transportation costs, as some mothers established their HIV care far from their home to avoid being recognized. Further, those who now needed to rely on financial or childcare support to make it to appointments in their postpartum year would find it difficult to do so without disclosing their HIV status.

Priority of pediatric care

由于这些经济和社会挑战的结果，人们会期望拒绝艾滋病毒护理的母亲也无法遵守其儿科艾滋病毒测试或儿童良好的访问时间表。但是，我们发现除了一名艾滋病毒护理的所有母亲（除一个母亲）都从事医疗保健系统以供孩子健康。这种行为表明，在有限的资源的背景下，母亲将孩子的健康优先考虑。

建议

To close the pregnancy-postpartum HIV-care retention gap, our results call for a package of interventions that minimize the economic burden of accessing HIV care, diminish stigma, and enhance the management of ART-related side effects. The women in our study recommended that HIV-care providers in Ghana consider extending their medication refills from three to six months. This option will not only reduce transportation costs, but it will also allow mothers to recover physically from childbirth. Ghana has the potential to eliminate MTCT of HIV; doing so will require a concerted and deliberate effort to support postpartum WLHIV to stay in HIV care.