I have always known I wanted to work with people. Since I was a little girl, I’ve been cleaning up neighborhood scratches and until a volunteer stint at a village clinic made me dizzyingly aware of my phobia towards needles, I thought I was going to be a nurse. But I ended up finding my calling in the Public Health field and love nothing more than to be surrounded by a group of individuals or even one-on-one and picking each others brains about how to help each other figure out this thing we call “health”.
Recently we held a focus group here at the clinic, to work with some of our clients on finding ways to prevent what we call “loss-to-follow-up”. Essentially, this is when a woman, usually pregnant, stops coming for her appointments and medication. When a woman is HIV positive and pregnant, the IHCC manages not only her pregnancy needs but also her medication, and ideally even after her child’s birth so that we can encourage her to have her baby tested for HIV. We don’t handle infant health needs like immunizations, so this is really asking a woman to make a special trip to come see us in order to do this test for her baby. Unfortunately, those women who stop coming for their antenatal appointments are those least likely to get their babies tested after giving birth which puts the child at risk
The purpose of this focus group was to get together with former clients of ours who had actually dropped out of the program and try to find out some of the factors that had led to the choices they made in order to see if there is a way we can provide more effective services. We quickly realized that a group session wasn’t going to work, even though we had carefully screened all the questions to be unbiased towards the HIV component. No one wanted to talk. So we had to switch tactics and go with individualized sessions. Mama Lu did a fantastic job conducting the interviews and Aisha was indispensable with her notes! By the end of the session, we had interviewed 11 women altogether and even one husband joined!
Although not all the results were as clear as we would have desired, our team confirmed some valuable information that will help us as we move forward. We learned that two of the major factors that contribute to loss to follow-up are a lack of finances and the transition that happens when a woman returns to her home area to deliver her baby, rather than delivering in her city of current residence. The financial aspect is a complex one, taking into consideration that many individuals have not disclosed their HIV status to their husband, who is often in control of finances. For example, an additional trip to the clinic to test the baby could throw suspicion on her. While we do have systems in place at IHCC to handle referrals whenever an individual is relocating, there is not always a facility nearby that handles ARVs. It is also harder to be self-sufficient when pregnant and not able to retrieve your medications yourself, especially immediately after delivery.
On a positive note, we did find that of the 11 women interviewed, 8 of them had tested their babies for HIV. Of those 8, 5 of them had done so at the IHCC, which means that counseling does have an impact!