Barriers to uptake of postnatal interventions for prevention of vertical HIV transmission in rural sub-Saharan Africa: a narrative review

BACKGROUND: Almost half of all vertical transmission occurs through breastfeeding. Understanding barriers to the uptake of postpartum PVT interventions, particularly in rural settings, would help to inform strategies to reach elimination targets. OBJECTIVE: To assess barriers to uptake of postnatal PVT interventions in rural sub-Saharan Africa through a narrative literature review. METHODS: A literature search was conducted in OVID EMBASE from January 2017 to January 2024. Although not a systematic review, we used a methodical approach to identify relevant literature. RESULTS: 18 studies were included. Two studies investigated the entire PVT cascade, while others focused on single interventions. Two main groups of factors were identified: individual-level barriers and facility-level barriers, with many consistent findings across countries. Individual-level barriers include stigma, poverty, lack of family support and insufficient education. Facility-level barriers included staff shortages, long turnaround times for infant testing, distance to health facilities, loss to follow-up after referrals, lack of resources, insufficient staff training and negative behaviour among healthcare workers. CONCLUSION: A range of individual-level and facility-level barriers to uptake of postpartum PVT interventions should be addressed to hasten progress towards paediatric HIV elimination targets.