Perspectives on postpartum continuity of antiretroviral therapy care at Volta Regional Hospital, Ghana

Human Immunodeficiency Virus remains a major global health issue, disproportionately affecting women in sub-Saharan Africa. Although access to antiretroviral therapy has increased, maintaining treatment during the postpartum period continues to be difficult. Poor retention raises the risk of viral rebound, drug resistance, mother-to-child transmission, and maternal health problems. This study explored how HIV-positive postpartum mothers, mentor mothers, and healthcare professionals experience and navigate postpartum ART care continuity at Volta Regional Hospital, Ghana.

An exploratory descriptive qualitative study was conducted among thirty HIV-positive postpartum mothers, two mentor mothers, and seven healthcare workers at Volta Regional Hospital, Ghana. Data were collected through face-to-face semi-structured interviews and a focus group discussion, and analysed using inductive thematic analysis with Atlas.ti version 7.5.0.

Out of 30 HIV-positive postpartum mothers, only 11 achieved optimal ART care continuity. Four analytical themes emerged: motherhood as the anchor of adherence; navigating stigma and secrecy across the care continuum; the embodied consequences of adherence and non-adherence; and structural gaps and human bridges. Whilst motherhood powerfully motivated adherence, the postpartum household, shaped by in-law presence, financial constraints, and partner dynamics, simultaneously created new barriers, making the postpartum period a site of competing forces rather than simply reduced motivation. Stigma operated as a structurally reproduced force across the antenatal-to-postpartum transition, with the shift from integrated ANC to standalone ART services increasing HIV service visibility and driving clinic avoidance, whilst non-disclosure differentially burdened women without partner support. Adherence and non-adherence produced immediate bodily consequences, with sustained treatment producing physical transformation and emotional normalisation, whilst disengagement brought rapid deterioration and initial side effects representing a critical vulnerability window. The transition from monthly antenatal to longer postpartum appointment intervals created a structural gap, within which mentor mothers emerged as critical human bridges spanning clinical, community, and relational dimensions of care.

Continuity of ART after childbirth was fragmented, placing mothers and infants at increased risk, and shaped by the interplay of personal, relational, and health system factors. Strengthening mentor mother programmes, structured couple counselling, and systematic postnatal follow-up are essential to improving postpartum ART retention. Equally, redesigning postpartum HIV service delivery to restore the protective integration of antenatal care is critical for addressing the structural drivers of disengagement identified in this study.