All ETDs from UAB

Advisory Committee Chair

Janet M Turin

Advisory Committee Members

Lisa L Abuogi

Henna Budhwani

Kristine R Hearld

Craig M Wilson

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


Under the current Kenyan guidelines, pregnant/postpartum women who test HIV-positive are immediately put on the lifelong antiretroviral (ART) therapy (Option B+) and are initiated into the prevention of mother-to-child (PMTCT) protocol. Gaps at each step of the PMTCT continuum undermine the positive impact of lifelong ART. Challenges at the individual, interpersonal, community, and health facility-levels contribute to these gaps. A community-based mentor mother (cMM) program tested under the Mother-Infant Visit Adherence and Treatment Engagement(MOTIVATE!) Trial (NICHD R01 R01HD080477; is a potential approach to address these challenges. The three manuscripts comprising this dissertation used qualitative and quantitative methods with the aims of understanding challenges to the implementation of the lifelong ART for pregnant/postpartum WLWH in southwestern rural Kenya at the healthcare facility level; evaluating the implementation and potential challenges related to the important PMTCT service of viral load (VL) testing during pregnancy/postpartum; and examining the potential effectiveness of a cMM program in addressing challenges related to adherence and retention in care. iv This dissertation revealed important challenges related to the provision of a lifelong ART for pregnant/postpartum women, including Option B+ specific challenges, facility resource constraints, and lack of client-friendly services. Significant gaps also exist in VL testing. A large proportion of women are not getting VL measurements at crucial times during pregnancy/breastfeeding and do not receive VL testing according to current Kenyan guidelines. Women newly diagnosed with HIV during pregnancy, those who have not disclosed their status to their male partner, and women with a history of viremia, less engagement in HIV care, and those on a second-line ART regimen appear to be particularly vulnerable. Utilizing an adapted conceptual framework for the role of community health workers in facilitating patients’ adoption of health behaviors, this study suggests that the cMM strategy has the potential to play an important role in enhancing PMTCT behaviors, and may also address barriers related to the provision of the Option B+ services and VL testing. Addressing these challenges may increase linkage, retention, and adherence to lifelong ART treatment for pregnant HIV-positive women in Kenya, contribute towards the elimination of mother-to-child transmission, and improve maternal/child outcomes.

Included in

Public Health Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.