Aims: This study will explore issues related to uptake of and adherence to interventions addressing the prevention of mother-to-child transmission of HIV in rural Tanzania. The study will examine how social and behavioral factors affect testing, counseling and treatment for HIV and PMTCT among pregnant women and recently-delivered mothers. This study will also investigate how clinical officers (such as nurses) and policy makers (such as district, regional and national health officials) view their role in providing PMTCT at th health facility-level, specifically the barriers or facilitating factors they face to providing effctive services or devising effective policies to help mothers. Ultimately, this research aims to provide stakeholders who are engaging in PTMCT interventions or policies with evidence on how to improve programs in a manner that is culturally acceptable and feasible in this context. Background: Although there has been an increased coverage of PMTCT programs globally, there are still many unresolved barriers to the program. In sub-Saharan Africa, cumulative losses to follow up in PMTCT programs range from 28% during antenatal care, up to 70% four months after delivery and close to 81% by six months post-partum. In southern Tanzania, a country that is among the hardest hit by the HIV/AIDS epidemic, there have been no published studies qualitatively investigating barriers to or facilitating factors in accessing PMTCT. The author of this study seeks to build on her previous research on careseeking among pregnant women and recently-delivered mothers in Tanzania by qualitatively exploring this issue. Findings from this study as well as all related instruments will be shared with stakeholders including policy makers and PMTCT implementers, with the intention of not only sharing findings but also sharing tools that may prove useful for data collection in similar settings. Methods: The study population will be based in Morogoro, Tanzania. In-depth interviews will take place with at least 10 health facility staff who provide PMTCT services, at least 10 policy makers who engage in PMTCT programming and implementation and at least 30 pregnant women or mothers, who are HIV-positive, between 18 and 35 years of age, and attended ante-natal care at the Morogoro Regional Hospital. The study will draw from quantitative knowledge gathered by the primary mentor of this proposal, but will be qualitative in nature and informed by Social Cognitive Theory and the Social-Ecological Model. The sampling strategy for interviewing mothers will involve coordination with physicians, home-based care providers and research staff to purposively identify a group of PMTCT patients. The sampling strategy for interviewing clinic staff and governmental officials will also be purposive, with an emphasis on identifying individuals who engage in provision of PMTCT services, namely individuals working within the Reproductive and Child Health Units of clinics and government offices.

Public Health Relevance

Many pregnant women and mothers in low-income countries prematurely drop out of programs that address the prevention of mother-to-child transmission (PMTCT) of HIV, and therefore miss the chance to access interventions that could save their lives or the lives of their babies. Few studies have explored the social and behavioral factors that influence women as they make this decision. Working in the context of a government initiative to provide more integrated maternal, newborn and PMTCT services, this study will qualitatively examine the experiences and attitudes of HIV positive, Tanzanian mothers and the health providers and policy makers who serve them with the aim of providing evidence-based recommendations to stakeholders on how to improve PMTCT interventions in a manner that is attentive to the needs of mothers and feasible within this context.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Stoff, David M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
McMahon, Shannon A; Winch, Peter J (2018) Systematic debriefing after qualitative encounters: an essential analysis step in applied qualitative research. BMJ Glob Health 3:e000837
McMahon, Shannon A; Kennedy, Caitlin E; Winch, Peter J et al. (2017) Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania. AIDS Behav 21:317-329
Chase, Rachel P; McMahon, Shannon A; Winch, Peter J (2016) ""Tell Me What You Don't Remember"": Care-Seeking Facilitators and Barriers in the Decade Following Repetitive Blast Exposure Among Army Combat Veterans. Mil Med 181:116-22
Gabrysch, Sabine; McMahon, Shannon A; Siling, Katja et al. (2016) Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement. Sci Rep 6:22578
McMahon, Shannon A; Chase, Rachel P; Winch, Peter J et al. (2016) Poverty, partner discord, and divergent accounts; a mixed methods account of births before arrival to health facilities in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 16:284
Chebet, Joy J; McMahon, Shannon A; Greenspan, Jesse A et al. (2015) ""Every method seems to have its problems""- Perspectives on side effects of hormonal contraceptives in Morogoro Region, Tanzania. BMC Womens Health 15:97
Chase, Rachel P; McMahon, Shannon A; Winch, Peter J (2015) Injury careers after blast exposure among combat veterans deployed to Iraq or Afghanistan. Soc Sci Med 147:309-16
McMahon, Shannon A; Mohan, Diwakar; LeFevre, Amnesty E et al. (2015) ""You should go so that others can come""; the role of facilities in determining an early departure after childbirth in Morogoro Region, Tanzania. BMC Pregnancy Childbirth 15:328
Greenspan, Jesse A; McMahon, Shannon A; Chebet, Joy J et al. (2013) Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. Hum Resour Health 11:52