“Getting pregnant during the COVID 19 was a big risk because getting the help from the clinic was not easy”: COVID-19 experiences of women and healthcare providers in Harare, Zimbabwe

Background The COVID-19 pandemic and associated measures may have disrupted delivery of maternal and neonatal healthcare services and reversed the progress made towards dual elimination of mother-to-child transmission of HIV and syphilis in Zimbabwe. This qualitative study explores the impact of the pandemic on the provision and uptake of prevention of mother-to-child transmission (PMTCT) services from the perspectives of women and maternal healthcare providers. Methods Longitudinal in-depth interviews were conducted with 20 pregnant and breastfeeding women aged 20-39 years living with HIV and 20 healthcare workers in two maternity polyclinics in low-income suburbs of Harare, Zimbabwe. Semi-structured interviews were held after the second and third waves of COVID-19 in March and November 2021 respectively. Data were analysed using the modified grounded theory approach. Results While eight antenatal care contacts are recommended by Zimbabwe’s Ministry of Health and Child Care, women reported only being able to access two contacts. At antenatal booking, women were told to return at onset of labour; subsequent visits were suspended. Healthcare workers reported this reduction in antenatal attendance was a result of limited availability of personal protective equipment and fear that patients and services providers would contract SARS-CoV-2. Although HIV testing, antiretroviral therapy (ART) refills and syphilis screening services were accessible at first contact, other services such as HIV-viral load monitoring and enhanced adherence counselling were not available for those on ART. Closure of clinics and shortened operating hours during the second COVID-19 wave resulted in more antenatal bookings occurring later during pregnancy and more home deliveries. Six of the 20 interviewed women reported giving birth at home assisted by untrained traditional midwives as clinics were closed. Babies delivered at home missed ART) prophylaxis and HIV testing at birth despite being HIV-exposed. Although women were faced with multiple challenges, they continued to attempt to access services after delivery. Conclusions The COVID-19 pandemic disrupted provision and uptake of PMTCT services; antenatal care contacts were significantly reduced, home deliveries increased, and babies born at home missed out on the necessary ARV prophylaxis. These findings underline the importance of investing in robust health systems that are able to respond to emergency situations to ensure continuity of essential HIV prevention, treatment, and care services. Summary box What is already known on this topic Studies have shown that the COVID-19 pandemic and associated control measures have disrupted provision of maternal and neonatal healthcare services globally. What this study adds The COVID-19 pandemic disrupted provision and uptake of PMTCT services; antenatal care contacts were significantly reduced, home deliveries increased, and babies born at home missed out on the necessary ARV prophylaxis. How this study might affect research, practice, or policy Our findings underline the importance of investing in robust health systems that are able to respond to emergency situations to ensure continuity of essential HIV prevention, treatment, and care services.