Initial reaction to HIV positive results during pregnancy and uptake of antiretroviral treatment among adolescents and young women; what are the implications for prevention of vertical transmission of HIV in Lesotho?

Introduction: In many settings in sub-Saharan Africa, most pregnant adolescent girls and young women (AGYW) are diagnosed with HIV during routine antenatal screening. Evidence points to low uptake of an-tiretroviral treatment (ART) in the immediate posttesting period, which put their infants at higher risk for HIV infection. Lesotho is one of the countries with high prevalence of HIV among this group, but limited studies have explored the experiences of pregnant AGYW with a positive diagnosis. This paper describes the initial reactions of AGYW after receiving the HIV positive results in pregnancy as well as their uptake of ART in the immediate post-testing period. Methods: The study took place in prevention of mother to child transmission (PMTCT) sites located in urban areas of Maseru, Lesotho. Qualitative descriptive phenomenology was adopted and 15 AGYW were interviewed. Analysis used an inductive design with a thematic approach. Results: Testing positive in pregnancy occurred in the context where most AGYW had not given thought to the routine antenatal HIV test. As such, they were emotionally unprepared for the positive test results. The AGYW reacted with intense shock, disbelief, fear, worry, sadness, and confusion. The intense emotions were compounded by the fear of vertical transmission of HIV and the urgency of initiating ART in the immediate post-testing period. In spite of all these emotions, most AGYW engaged in HIV care through the services offered in the PMTCT program. Conclusion: The primary reason for initiating ART was to protect their unborn child. Hesitancy to initiate ART at the point of HIV diagnosis has implications for PMTCT interventions. Strengthening the pro-graming for pregnant AGYW is essential to reaching global elimination of mother-to-child transmission goals.