Breastfeeding: the hidden barrier in Cote d'Ivoire's quest to eliminate mother-to-child transmission of HIV

Introduction: Cote d'Ivoire has one of the worst HIV/AIDS epidemics in West Africa. This study sought to understand how HIV-positive women's life circumstances and interactions with the public health care system in Bouake, Cote d'Ivoire, influence their self-reported ability to adhere to antiretroviral prophylaxis during pregnancy. Methods: Semistructured interviews were conducted with 24 HIV-positive women not eligible for antiretroviral therapy and five health care workers recruited from four public clinics in which prevention of mother-to-child transmission services had been integrated into routine antenatal care. Results: Self-reported adherence to prophylaxis is high, but women struggle to observe (outdated) guidelines for rapid infant weaning. Women's positive interactions with health providers, their motivation to protect their infants and the availability of free antiretrovirals seem to override most potential barriers to prophylaxis adherence. Conclusions: This study reveals the importance of considering the full continuum of prevention of mother-to-child transmission interventions, including infant feeding, instead of focussing primarily on prophylaxis for the mother and newborn.