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Belachew TW, Erega BB, Ewunetu M, Gelaye K, Yimer TS, Ferede WY. Level of option B plus drug adherence for preventing mother-to-child transmission of HIV and associated factors among HIV-positive women in the awi zone, amhara region, northwest Ethiopia,2020. Heliyon 2024; 10:e35319. [PMID: 39161839 PMCID: PMC11332886 DOI: 10.1016/j.heliyon.2024.e35319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Adherence to Option B+ antiretroviral medication (ART) is essential for the successful implementation of the Prevention of Mother-to-Child Transmission (PMTCT) program. However, poor adherence to Option B + PMTCT drugs among women results in increased viral load and mother-to-child transmission and reduces immunological and clinical outcomes. Objective The objective of the study was to assess the level of Option B plus drug adherence for preventing mother-to-child transmission of HIV and associated factors among HIV positive women in selected government health facilities of Awi zone, Amhara region, Northwest Ethiopia,2020. Methods This institutional-based cross-sectional study was conducted from March 1 to April 30 among 358 HIV-positive women (pregnant and lactating mothers). A multistage sampling procedure was used to select the study participants. Data were collected using a structured questionnaire through interviews. The collected data were entered into EPI Data 3.1 statistical software for data management and analyzed using SPSS version 25 statistical package. The associations between variables were analyzed using bivariate and multivariable logistic regression models. A p-value ≤0.05 at the 95 % confidence interval was considered statistically significant. Results Out of the 358 participants, adherence to Option B + PMTCT was 83.24 %. The study revealed that counselling [AOR = 4.4, 95 % CI: 1.60-12.29], partner support involvement [AOR = 3.0, 95 % CI: 1.17-7.92], and time taken to reach from home to the facility [AOR = 3.1, 95 % CI: 1.51-6.52] were significantly associated with the level of adherence to Option B + PMTCT. Conclusion This study showed that the level of Option B + PMTCT drug adherence was lower than the nationally recommended adherence level. Good counselling, partner support, and reduced travel time from home to the facility were associated with adherence to Option B + PMTCT drugs. Therefore, counselling is crucial for increasing adherence to Option B + PMTCT drugs. Accessible health facilities reduce travel burdens, encourage regular clinic visits, and enhance adherence to PMTCT drugs. Partners can provide reminders, attend appointments, offer emotional support, and explore alternatives such as mobile clinics or medication delivery services.
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Affiliation(s)
- Tegegne Wale Belachew
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Besfat Berihun Erega
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Mesafint Ewunetu
- Department of Midwifery College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Kihinetu Gelaye
- Department of Midwifery College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Tigist Seid Yimer
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
| | - Wassie Yazie Ferede
- Department of Midwifery College of Medicine and Health Sciences, Debre Tabor University, Ethiopia
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Audet CM, Graves E, Shepherd BE, Prigmore HL, Brooks HL, Emílio A, Matino A, Paulo P, Diemer MA, Frisby M, Sack DE, Aboobacar A, Barreto E, Van Rompaey S, De Schacht C. Partner-Based HIV Treatment for Seroconcordant Couples Attending Antenatal and Postnatal Care in Rural Mozambique: A Cluster Randomized Controlled Trial. J Acquir Immune Defic Syndr 2024; 96:259-269. [PMID: 38905476 PMCID: PMC11196005 DOI: 10.1097/qai.0000000000003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/25/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION There is evidence that a supportive male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral therapy initiation and adherence, and increases HIV-free infant survival. Most male partner engagement clinical strategies have focused on increasing uptake of couple-based HIV testing and counseling. We delivered a couple-based care and treatment intervention to improve antiretroviral therapy adherence in expectant couples living with HIV. METHODS We implemented a cluster randomized controlled trial for seroconcordant couples living with HIV, comparing retention (using a patient's medication possession ratio) in HIV care for a couple-based care and treatment intervention vs. standard of care services in rural Mozambique. The intervention included couple-based treatment, couple-based education and skills building, and couple-peer educator support. RESULTS We recruited 1080 couples to participate in the study. Using a linear mixed effect model with a random effect for clinic, the intervention had no impact on the medication possession ratio among women at 12 months. However, the intervention increased men's medication ratio by 8.77%. Our unadjusted logistic regression model found the odds of an infant seroconverting in the intervention group was 30% less than in the control group, but the results were not statistically significant. DISCUSSION Our study found no difference in maternal outcomes by study arm, but our intervention resulted in an improved medication possession ratio among male partners. We provide a community/clinic-based treatment framework that can improve outcomes among male partners. Further work needs to be done to improve social support for pregnant women and to facilitate prevention of vertical transmission to infants among couples living with HIV.
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Affiliation(s)
- Carolyn M Audet
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | - Erin Graves
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Heather L Prigmore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Hannah L Brooks
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | | | | | - Paula Paulo
- Friends in Global Health, Quelimane, Mozambique
| | | | - Michael Frisby
- Department of Educational Policy Studies, Georgia State University, Atlanta, GA; and
| | - Daniel E Sack
- Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Nashville, TN
| | - Arifo Aboobacar
- Provincial Health Directorate of Zambézia, Quelimane, Mozambique
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Ayele AD, Kassa BG, Mihretie GN, Belay HG, Sewyew DA, Semahegn AM, Yehuala ED, Tiruneh GA, Tenaw LA, Sendekie AD, Teffera AG, Aychew EW, Belachew YY, Liyeh TM, Worke MD. Level of adherence to option B+ program and associated factors among HIV-positive women in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0298119. [PMID: 38662634 PMCID: PMC11045077 DOI: 10.1371/journal.pone.0298119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite policy initiatives and strategic measures highly focused on preventing mother-to-child transmission through the implementation of the Option B+ program, adherence to the treatment is still challenging. The level of adherence and determinants of Option B+ program utilization reported by different studies were highly inconsistent in Ethiopia. Hence, this systematic review and meta-analysis aimed to estimate the pooled prevalence of adherence to the Option B+ program and its predictors among HIV-positive women in Ethiopia. METHODS PubMed, Google Scholar, EMBASE, HINAR, Scopus, and Web of Sciences were searched for published articles from March 2010 to March 2022. The pooled prevalence of adherence was estimated using a weighted DerSimonian-Laird random effect model. The I2 statistics was used to identify the degree of heterogeneity. Publication bias was also assessed using the funnel plot and Egger's regression test. RESULTS A total of 15 studies were included. The pooled estimate of the option B+ program among HIV-positive women in Ethiopia was 81.58% (95% CI: 77.33-85.84). Getting social and financial support (AOR = 3.73, 95% CI: 2.12, 6.58), disclosure of HIV status to partners (AOR = 2.05, 95% CI: 1.75, 2.41), time to reach a health facility (AOR = 0.33, 95% CI: 0.16, 0.67), receiving counseling on drug side effects (AOR = 4.09, 95% CI: 2.74, 6.11), experience of drug side effects (AOR = 0.17, 95% CI: 0.08, 0.36), and knowledge (AOR = 4.73, 95% CI: 2.62, 8.51) were significantly associated with adherence to the Option B+ program. CONCLUSION This meta-analysis showed that the level of adherence to the Option B+ program in Ethiopia is lower than the 95% level of adherence planned to be achieved in 2020. Social and financial support, disclosure of HIV status, time to reach the health facility, counseling, drug side effects, and knowledge of PMTCT were significantly associated with option B+ adherence. The findings of this meta-analysis highlight that governmental, non-governmental, and other stakeholders need to design an effective strategy to scale up the level of disclosing one's own HIV status, access health facilities, improve knowledge of PMTCT, and counsel the potential side effects of Option B+ drugs, and advocate the program to reduce the multidimensional burden of HIV/AIDS. TRIAL REGISTRATION Prospero registration: CRD42022320947. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320947.
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Affiliation(s)
- Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Gebrehana Belay
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dagne Addisu Sewyew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abenezer Melkie Semahegn
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Enyew Dagnew Yehuala
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Lebeza Alemu Tenaw
- School of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | | | - Adanech Getie Teffera
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Eden Workneh Aychew
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yismaw Yimam Belachew
- School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tewachew Muche Liyeh
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Fassinou LC, Songwa Nkeunang D, Delvaux T, Nagot N, Kirakoya-Samadoulougou F. Adherence to option B + antiretroviral therapy and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:94. [PMID: 38183014 PMCID: PMC10768427 DOI: 10.1186/s12889-023-17004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND To assess the adherence to option B + antiretroviral therapy (ART) and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa (SSA). METHODS We conducted a comprehensive search from 01st January 2012 to 03rd October 2022, across four databases: PubMed, Scopus, Proquest Central, and Index Medicus Africain, to identify studies focused on pregnant and/or breastfeeding women living with HIV and receiving option B+ ART in SSA. Studies reporting adherence data were included in the meta-analysis. Were excluded studies published before 01st January 2012, grey literature, systematic reviews, and meta-analysis studies. Articles selection and data extraction were performed independently by two reviewers. We evaluated pooled adherence and pooled association between various factors and adherence using a random-effects model. RESULTS Overall, 42 studies involving 15,158 participants across 15 countries contributed to the meta-analysis. The overall pooled adherence was 72.3% (95% CI: 68.2-76.1%). Having high education level (pooled odds ratio (OR): 2.25; 95% CI: 1.57-3.21), living in urban area (pooled OR: 1.75; 95% CI: 1.10-2.81), disclosing status to a family/partner (pooled OR: 1.74; 95% CI: 1.27-2.40), having a support system (pooled OR: 3.19; 95% CI: 1.89-5.36), receiving counseling (pooled OR: 3.97; 95% CI: 2.96-5.34), initiating ART at early clinical HIV stage (pooled OR: 2.22; 95% CI: 1.08-4.56), and having good knowledge on PMTCT/HIV (pooled OR: 2.71; 95% CI: 1.40-5.25) were factors significantly associated with adherence to option B + ART. CONCLUSIONS Despite the implementation of option B+ ART, the level of adherence among pregnant and breastfeeding women in SSA falls short of meeting the critical thresholds for viral load suppression as outlined in the 95-95-95 objectives set for 2025. These objectives are integral for achieving HIV elimination, and in turn, preventing HIV mother-to-child transmission. To bridge this gap, urgent tailored interventions based on individual and structural factors are essential to enhance adherence within these subgroups of women. This targeted approach is crucial in striving towards the HIV elimination target in SSA.
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Affiliation(s)
- Lucresse Corine Fassinou
- INSSA, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso.
- Centre de Recherche en Epidémiologie, Biostatistique Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgique.
| | - Diane Songwa Nkeunang
- Centre de Recherche en Epidémiologie, Biostatistique Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgique
| | - Thérèse Delvaux
- Institute of Tropical Medicine, Department of Public Health, Antwerp, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, Univ. Montpellier, INSERM, Univ. Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistique Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgique
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Geremew H, Geremew D, Abdisa S, Dessie AM, Kassa GM, Moges NA. Adherence to option B+ PMTCT program and its predictors among HIV-positive women in Ethiopia. A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1404. [PMID: 37425229 PMCID: PMC10323164 DOI: 10.1002/hsr2.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Previously, few studies investigated level of adherence to option B+ lifelong antiretroviral therapy (ART) in Ethiopia. However, their findings were inconsistent. Therefore, this review aimed to determine the pooled magnitude of adherence to option B+ lifelong ART and its predictors among human immune virus (HIV)-positive women in Ethiopia. Methods A comprehensive web-based search was conducted using PubMed, Cochrane Library, Science Direct, Google scholar, and African Journals Online databases to retrieve relevant articles. STATA 14 statistical software was used to carry out the meta-analysis. We used the random effects model to account for the large heterogeneity across included studies. Egger's regression test in conjunction with funnel plot and I 2 statistics were utilized to assess publication bias and heterogeneity among included studies respectively. Result Twelve studies with a total of 2927 study participants were involved in this analysis. The pooled magnitude of adherence to option B+ lifelong ART was 80.72% (95% confidence interval [CI]: 77.05-84.39; I 2 = 85.4%). Disclosure of sero-status (OR 2.58 [95% CI: 1.55-4.3]), receiving counseling (OR 4.93 [95% CI: 3.21-7.57]), attending primary school and above (OR 2.45 [95% CI: 1.31-4.57]), partner support (OR 2.24 [95% CI: 1.11, 4.52]), good knowledge about prevention of mother-to-child transmission (PMTCT) (OR 4.22 [95% CI: 2.02-8.84]), taking less time to reach health facility (OR 1.64 [95% CI: 1.13-2.4]), and good relation with care provider (OR 3.24 [95% CI: 1.96-5.34]) were positively associated with adherence. Whereas, fear of stigma and discrimination (OR 0.12 [95% CI: 0.06-0.22]) and advanced disease stage (OR 0.59 [95% CI: 0.37-0.92]) were negatively associated. Conclusion The level of adherence to option B+ lifelong ART was suboptimal. Strengthened comprehensive counseling and client education on PMTCT, HIV status disclosure, and male partner involvement are important to eliminate mother to child transmission and control the pandemic.
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Affiliation(s)
- Habtamu Geremew
- College of Health SciencesOda Bultum UniversityChiroEthiopia
| | - Demeke Geremew
- Department of Medical Laboratory Sciences, Immunology and Molecular Biology Unit, College of Medicine and Health SciencesBahir Dar UniversityBahir DarEthiopia
| | - Samuel Abdisa
- College of Health SciencesOda Bultum UniversityChiroEthiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health SciencesDebre Tabor UniversityDebre TaborEthiopia
| | - Getachew Mullu Kassa
- Department of Public Health, College of Health SciencesDebre Markos UniversityDebre MarkosEthiopia
| | - Nurilign Abebe Moges
- Department of Public Health, College of Health SciencesDebre Markos UniversityDebre MarkosEthiopia
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Mwamuye IC, Karanja S, Msanzu JB, Adem A, Kerich M, Ngari M. Factors associated with poor outcomes among people living with HIV started on anti-retroviral therapy before and after implementation of "test and treat" program in Coastal Kenya. PLoS One 2022; 17:e0270653. [PMID: 36129876 PMCID: PMC9491584 DOI: 10.1371/journal.pone.0270653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine the factors associated with poor outcomes among people living with HIV (PLHIV) started on anti- retroviral therapy before and after implementation of "Test and treat" program in 18 facilities in Coastal Kenya. METHODS A retrospective cohort study design was used to study PLHIV aged > 15 years and started on ART in the periods of April to August 2016, and April to August 2017, then followed up for 24 months. Primary outcome was retention defined as being alive and on ARVs after 24 months. Death and loss to follow-up were considered as poor outcomes. Kaplan-Meier survival methods were used to describe time to primary outcome. Cox proportional regression analysis was used to determine factors associated with poor outcomes. RESULTS 86 patients (470 before test and treat, and 316 after test and treat cohorts) were enrolled. Overall, the median [IQR] age was 39.3 [32.5-47.5] years and 539 (69%) were female. After 24 months, retention rates for the before (68%) and after (64%) test and start groups were similar (absolute difference: -4.0%, 95%CI: -11-3.1, P = 0.27). There were 240(31%, 95%CI 27 to 34%) PLHIV with poor outcomes, 102 (32%) and 138 (29%) occurred among the test and treat group, and delayed treatment patients respectively. In multivariable regression model, test and treat had no significant effect on risk of poor outcomes (aHR = 1.17, 95%CI 0.89-1.54). Increasing age (aHR = 0.98, 95%CI 0.97-0.99), formal employment (aHR = 0.42, 95%CI 0.23-0.76) and not being employed (aHR = 0.53, 95%CI 0.34-0.81) were negatively associated with poor outcomes. The risk of poor outcomes was higher among males compared to female patients (aHR = 1.37, 95%CI 1.03-1.82) and among divorced/separated patients compared to the married (aHR = 1.44, 95%CI 1.04-1.99). CONCLUSION Retention patterns for the "test and treat" cohort were comparable to those who started ART before "test and treat". Patients who are males, young, divorced/separated, with poor socio-economic status had higher risks for poor clinical outcomes. Interventions targeting PLHIV who are young, male and economically disadvantaged provide an opportunity to improve the long-term outcomes.
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Affiliation(s)
| | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | | | - Aggrey Adem
- Technical University of Mombasa, Mombasa, Kenya
| | - Mary Kerich
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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Adugna Wubneh C, Dessalegn Mekonnen B, Wesenyeleh Delelegn M, Asmare Atalell K. Adherence to option B+ and its association with disclosure status and counseling among HIV-positive pregnant and lactating women in Ethiopia: systematic review and meta-analysis. Public Health 2022; 211:105-113. [PMID: 36058198 DOI: 10.1016/j.puhe.2022.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/22/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to assess the pooled estimate of option B+ level of adherence and its association with disclosure status and counseling among pregnant and lactation women in Ethiopia after option B+ implementation. STUDY DESIGN Systematic review and meta-analysis. METHODS We searched Web of Science, MEDLINE, PUBMED, Scopus, Embase, CINAHL, and Google Scholar databases for studies reporting adherence to option B+ and its association with disclosure status and counseling among pregnant and lactating women in Ethiopia. Heterogeneity was assessed by forest plot, Cochran's Q test, and I2 test. A random effects model was calculated to estimate the pooled prevalence of adherence toward option B+. RESULTS We included eight studies, which gives a total of 1852 pregnant and lactating women in this systematic review and meta-analysis. The overall pooled estimate of good adherence toward option B+ antiretroviral therapy (ART) drug among pregnant and lactating women in Ethiopia was 84.23% (95% confidence interval [CI]: 80.79-87.66). Women who have disclosed their HIV status to their partner (adjusted odds ratio = 4.48, 95% CI: 1.86-10.76) and got counseling during the antenatal period (adjusted odds ratio = 5.02, 95% CI: 2.43-10.34) had a positive association with good adherence to option B+ ART drugs. CONCLUSION Four of five pregnant and lactating women have good adherence to option B+ ART drugs in Ethiopia. Therefore, promoting HIV disclosure status to partners and enhancing counseling services should be strengthened to improve adherence toward option B+ among pregnant and lactating women.
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Affiliation(s)
- Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia.
| | - Birye Dessalegn Mekonnen
- Department of Nursing, Teda Health Science College, Gondar, Ethiopia, P.O.BOX: 790, Gondar, Ethiopia.
| | - Mekdess Wesenyeleh Delelegn
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia.
| | - Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, P.O.BOX: 196, Gondar, Ethiopia.
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Nutor JJ, Marquez S, Slaughter-Acey JC, Hoffmann TJ, DiMaria-Ghalili RA, Momplaisir F, Opong E, Jemmott LS. Water Access and Adherence Intention Among HIV-Positive Pregnant Women and New Mothers Receiving Antiretroviral Therapy in Zambia. Front Public Health 2022; 10:758447. [PMID: 35433591 PMCID: PMC9010721 DOI: 10.3389/fpubh.2022.758447] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/11/2022] [Indexed: 01/07/2023] Open
Abstract
Background Mother-to-infant transmission of HIV is a major problem in Sub-Saharan Africa despite free or subsidized antiretroviral treatment (ART), but is significantly reduced when mothers adhere to ART. Because potable water access is limited in low-resource countries, we investigated water access and ART adherence intention among HIV-positive pregnant women and new mothers in Zambia. Methods Our convenience sample consisted of 150 pregnant or postpartum women receiving ART. Descriptive statistics compared type of water access by low and high levels of ART adherence intention. Results Most (71%) had access to piped water, but 36% of the low-adherence intention group obtained water from a well, borehole, lake or stream, compared to only 22% of the high-adherence intention group. The low-adherence intention group was more rural (62%) than urban (38%) women but not statistically significant [unadjusted Prevalence Ratio (PR) 0.73, 95% CI: 0.52-1.02; adjusted PR 1.06, 95% CI: 0.78-1.45]. Conclusion Providing potable water may improve ART adherence. Assessing available water sources in both rural and urban locations is critical when educating women initiating ART.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | - Shannon Marquez
- Undergraduate Global Engagement, Columbia University, New York City, NY, United States
| | - Jaime C. Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Thomas J. Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA, United States
| | | | - Florence Momplaisir
- School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Loretta Sweet Jemmott
- College of Nursing and Health Professions Drexel University, Philadelphia, PA, United States
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Abebe W, Gebremariam M, Molla M, Teferra S, Wissow L, Ruff A. Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia. PLoS One 2022; 17:e0262638. [PMID: 35051244 PMCID: PMC8775187 DOI: 10.1371/journal.pone.0262638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Vertical transmission of HIV remains one of the most common transmission modes. Antiretroviral therapy (ART) decreases the risk of transmission to less than 2%, but maintaining adherence to treatment remains a challenge. Some of the commonly reported barriers to adherence to ART include stress (physical and emotional), depression, and alcohol and drug abuse. Integrating screening and treatment for psychological problem such as depression was reported to improve adherence. In this study, we sought to determine the prevalence of depression and its association with adherence to ART among HIV-positive pregnant women attending antenatal care (ANC) clinics in Addis Ababa, Ethiopia.
Methods
We conducted a cross-sectional survey from March through November 2018. Participants were conveniently sampled from 12 health institutions offering ANC services. We used the Patient Health Questionnaire-9 (PHQ-9) to screen for depression and the Center for Adherence Support Evaluation (CASE) Adherence index to evaluate adherence to ART. Descriptive statistics was used to estimate the prevalence of depression during third-trimester pregnancy and nonadherence to ART. A bivariate logistic regression analysis was used to get significant predictors for each of the two outcome measures. The final multivariable logistic regression analysis included variables with a P<0.25 in the bivariate logistic regression model; statistical significance was evaluated at P<0.05.
Results
We approached 397 eligible individuals, of whom 368 (92.7%) participated and were included in the analysis. Of the total participants, 175(47.6%) had depression. The participants’ overall level of adherence to ART was 82%. Pregnant women with low income were twice more likely to have depression (AOR = 2.10, 95%CI = 1.31–3.36). Women with WHO clinical Stage 1 disease were less likely to have depression than women with more advanced disease (AOR = 0.16, 95%CI = 0.05–0.48). There was a statistically significant association between depression and nonadherence to ART (P = 0.020); nonadherence was nearly two times higher among participants with depression (AOR = 1.88, 95%CI = 1.08–3.27).
Conclusion
We found a high prevalence of depression among HIV-positive pregnant women in the selected health facilities in Addis Ababa, and what was more concerning was its association with higher rates of nonadherence to ART adversely affecting the outcome of their HIV care. We recommend integrating screening for depression in routine ANC services.
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Affiliation(s)
- Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Mahlet Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mitike Molla
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Larry Wissow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Andrea Ruff
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
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10
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van Lettow M, Tippett Barr BA, van Oosterhout JJ, Schouten E, Jahn A, Kalua T, Auld A, Nyirenda R, Wadonda N, Kim E, Landes M. The National Evaluation of Malawi's PMTCT Program (NEMAPP) study: 24-month HIV-exposed infant outcomes from a prospective cohort study. HIV Med 2021; 23:573-584. [PMID: 34970836 PMCID: PMC9303195 DOI: 10.1111/hiv.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Data on long-term HIV-free survival in breastfeeding, HIV-exposed infants (HEIs) are limited. The National Evaluation of Malawi's Prevention of Mother-to-Child Transmission (PMTCT) Program (NEMAPP), conducted between 2014 and 2018, evaluated mother-to-child transmission (MTCT) and infant outcomes up to 24 months postpartum. METHODS We enrolled a nationally representative cohort of HEIs at 54 health facilities across four regional strata in Malawi and used multivariable Cox regression analysis to investigate the risk of adverse outcomes (HIV transmission, infant death and loss to follow-up) to 24 months postpartum. Models, controlling for survey design, were fitted for the total cohort (n = 3462) and for a subcohort that received maternal viral load (VL) monitoring (n = 1282). RESULTS By 24 months, in 3462 HEIs, weighted cumulative MTCT was 4.9% [95% confidence interval (CI) 3.7-6.4%], 1.3% (95% CI 0.8-2.2%) of HEIs had died, 26.2% (95% CI 24.0-28.6%) had been lost to follow-up and 67.5% (95% CI 65.0-70.0%) were alive and HIV-free. Primiparity [weighted adjusted hazard ratio (aHR) 1.6; 95% CI 1.1-2.2; parity 2-3: weighted aHR 1.5; 95% CI 1.2-1.9], the mother not disclosing her HIV status to her partner (no disclosure: weighted aHR 1.3; 95% CI 1.1-1.6; no partner: weighted aHR 0.7; 95% CI 0.5-0.9), unknown maternal ART start (weighted aHR 2.0; 95% CI 1.0-3.9) and poor adherence (missed ≥ 2 days of ART in the last month: weighted aHR 1.7; 95% CI 1.2-2.2; not on ART: weighted aHR 1.7; 95% CI 1.0-2.7) were associated with adverse outcomes by 24 months. In the subcohort analysis, risk of HIV transmission or infant death was higher among HEIs whose mothers started ART post-conception (during pregnancy: weighted aHR 3.2; 95% CI 1.3-7.7; postpartum: weighted aHR 12.4; 95% CI 1.5-99.6) or when maternal viral load at enrolment was > 1000 HIV-1 RNA copies/mL (weighted aHR 15.7; 95% CI 7.8-31.3). CONCLUSIONS Infant positivity and infant mortality at 24 months were low for a breastfeeding population. Starting ART pre-conception had the greatest impact on HIV-free survival in HEIs. Further population-level reduction in MTCT may require additional intervention during breastfeeding for women new to PMTCT programmes. Pre-partum diagnosis and linkage to ART, followed by continuous engagement in care during breastfeeding can further reduce MTCT but are challenging to implement.
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Affiliation(s)
- Monique van Lettow
- Dignitas International, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Nyanja Health Research Institute, Salima, Malawi
| | - Beth A Tippett Barr
- Nyanja Health Research Institute, Salima, Malawi.,US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,Department of Medicine, College of Medicine University of Malawi, Blantyre, Malawi
| | | | - Andreas Jahn
- Malawi Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi.,International Training Education and Community Health (ITECH), Lilongwe, Malawi
| | - Thokozani Kalua
- Malawi Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi
| | - Andrew Auld
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Rose Nyirenda
- Malawi Ministry of Health, Department of HIV and AIDS, Lilongwe, Malawi
| | - Nellie Wadonda
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Evelyn Kim
- US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Megan Landes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Nyanja Health Research Institute, Salima, Malawi.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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11
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Mbatha TL, Dube A. HIV Positive Pregnant Mothers' Perceptions and Experiences Regarding the Prevention of Mother-to-Child Transmission, Option B+ Program. J Patient Exp 2021; 8:23743735211065272. [PMID: 34901413 PMCID: PMC8655469 DOI: 10.1177/23743735211065272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: eSwatini is a small population-sized sub-Sahara African country characterized by its highest human immunodeficiency virus (HIV) prevalence globally. The prevalence of HIV among pregnant women is above 40%. In the past decade, the Government of eSwatini has demonstrated a high level of commitment to virally suppress HIV spread among its population. This study explored the perceptions and experiences of HIV-positive pregnant mothers regarding the prevention of mother-to-child transmission (PMTCT) Option B+ program in order to discuss and address the gaps in the health system. Methods: Qualitative, exploratory, and descriptive research design was used. Data was collected through in-depth interviews and field notes. Data was gathered from all cases of HIV-positive pregnant mothers enrolled at a Public Health Unit. Results: Seventeen pregnant women aged between 18 and 40 years participated. Findings revealed that the Option B+ program was positively perceived as preventing HIV from mother-to-child. It boosts the immune system, deters opportunistic infections, and prolongs life. Knowledge and understanding of the program were displayed despite challenges such as discrimination and no support from families. Conclusion: PMTCT Option B+ intervention was found to be effective in reducing mother-to-child transmission of HIV. Gaps between women and men about HIV and antiretroviral therapy need to be addressed through target messaging and stigmatization discussions so that men are encouraged to disclose their HIV status. Improving access to antiretroviral and retention of women on treatment can further reduce vertical HIV infection transmission.
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Affiliation(s)
- Trusty L Mbatha
- Department of Nursing Sciences, Southern Africa Nazarene University, Manzini, Swaziland
| | - Adiele Dube
- Department of Nursing Sciences, Southern Africa Nazarene University, Manzini, Swaziland
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12
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Tsegaye R, Etafa W, Wakuma B, Mosisa G, Mulisa D, Tolossa T. Withdrawn: Magnitude of Adherence to Option B plus program and associated factors among women in Eastern African Countries: A Systematic Review and Meta-analysis. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Abdisa S, Tenaw Z. Level of adherence to option B plus PMTCT and associated factors among HIV positive pregnant and lactating women in public health facilities of Hawassa city, Southern Ethiopia. PLoS One 2021; 16:e0255808. [PMID: 34352020 PMCID: PMC8341661 DOI: 10.1371/journal.pone.0255808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy is very essential to achieve a great outcome of drugs via suppressing viral load, preventing multidrug resistance, and reducing mother to a child transmission rate of the Human Immune Virus. OBJECTIVE This study aimed to assess the level of adherence to option B plus PMTCT and associated factors among HIV Positive pregnant and lactating women in public health facilities of Hawassa city, Southern Ethiopia, 2020 G.C. METHODS Institution-based cross-sectional study was done on 254 HIV-positive pregnant and lactating women attending the prevention of mother-to-child transmission (PMTCT) follow-up. Participants were selected by simple random sampling. Data collected through a structured interviewer-administered questionnaire were cleaned and entered into Epi-data 3.1 and exported to SPSS 20 for statistical analysis. Descriptive analysis was done. Bivariable and multivariable logistic regressions were done to measure the strength of association between independent and dependent variables using the odds ratio and 95% of confidence interval. A p-value <0.05 was taken as statistically significant. RESULT The overall adherence level to option B+ was 224 (88.2%). Respondents in age group of ≤ 25 [AOR = 0.12, 95% CI (0.03, 0.42)], with no formal education [AOR = 0.12, 95% CI (0.03, 0.51)], experienced drug side effects [AOR = 0.11, 95% CI (0.04, 0.32)], have good knowledge of PMTCT [AOR = 3.6, 95% CI (1.16, 11.3)], and get support from partner/family [AOR = 4.5, 95% CI (1.62, 12.4)] were identified associated factors with adherence level. CONCLUSION The level of adherence to option B plus PMTCT was 88.2% which is suboptimal. Ages, educational level, knowledge on PMTCT, getting support from partner/family, and drug side effect were significantly associated with adherence. Therefore, educating and counseling on the service of PMTCT to improve their knowledge and encouraging partner/family involvement in care are mandatory to achieve the standard adherence level.
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Affiliation(s)
- Samuel Abdisa
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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14
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Aferu T, Doang G, Zewudie A, Nigussie T. Adherence to Antiretroviral Therapy Among HIV-Positive Pregnant Women on followup at Mizan Tepi University Teaching and Tepi General Hospitals, Southwest Ethiopia. J Prim Care Community Health 2021; 11:2150132720902561. [PMID: 32321354 PMCID: PMC7180300 DOI: 10.1177/2150132720902561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The introduction of highly active antiretroviral therapy
has not only improved longevity in human immunodeficiency virus (HIV)–infected
individuals but in addition has had a significant impact on the rate of
mother-to-child transmission of the infection. Objective: To assess
antiretroviral therapy adherence among HIV-positive pregnant women on follow-up
at antiretroviral therapy clinic of Mizan Tepi University Teaching and Tepi
General Hospitals. Methods: A descriptive cross-sectional study was
undertaken in antiretroviral therapy clinics of Mizan Tepi University Teaching
and Tepi General Hospitals from April to May 2018. Data were collected through
face to face interview using structured and pretested questionnaires and
analyzed using Statistical Package for Social Sciences version 20.
Results: Majority of the patients had good adherence to their
antiretroviral therapy, 68 (66.00%). Medication side effects, 12 (34.00%) and
forgetfulness and distance of the hospital from home, each accounting 11
(31.00%) were the main reasons for nonadherence among nonadherent patients.
Frequency of counseling (P = .000), CD4 count (χ2 =
37.529, P = .000), World Health Organization’s clinical stage
(χ2 = 17.515, P = .000), stigma (χ2 =
70.426, P = .000), and family support (χ2 = 46.383,
P = .000) were found to be associated with patients’
medication adherence. Conclusion: The overall patient adherence to
antiretroviral therapy in the study facilities was good. Collaborative work
among patients, health care organizations, and the public are necessary to
tackle the adherence obstacles and enhance patient adherence to the prescribed
medication.
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Affiliation(s)
| | - Gatluak Doang
- Nyinenyang Hospital, Gambela Region, Gambela, Ethiopia
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15
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Nutor JJ, Agbadi P, Hoffmann TJ, Anguyo G, Camlin CS. Examining the relationship between interpersonal support and retention in HIV care among HIV+ nursing mothers in Uganda. BMC Res Notes 2021; 14:224. [PMID: 34082834 PMCID: PMC8176692 DOI: 10.1186/s13104-021-05639-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/26/2021] [Indexed: 01/24/2023] Open
Abstract
Objective The global burden of HIV on women and pediatric populations are severe in sub-Saharan Africa. Global child HIV infection rates have declined, but this rate remains quite high in sub-Saharan Africa due to Mother-to-child transmission (MTCT). To prevent MTCT of HIV, postpartum women living with HIV (WLHIV) are required to return to a health facility for HIV care within 60 days after childbirth (Retention in HIV care). Studies suggest that interpersonal support was positively associated with retention in HIV care. However, information on this association is lacking among postpartum WLHIV in Uganda. Therefore, this study investigates the relationship between interpersonal support, measured with the Interpersonal Support Evaluation List (ISEL-12), and retention in HIV care. Results In a total of 155 postpartum WLHIV, 84% were retained in HIV care. ISEL-12 was negatively associated with retention in HIV care. Postpartum WLHIV retained in care (24.984 ± 4.549) have lower ISEL-12 scores compared to the non-retained group (27.520 ± 4.224), t(35.572) = − 2.714, p = 0.01. In the non-income earning sample, respondents retained in care (24.110 ± 4.974) have lower ISEL scores compared to the non-retained group (27.000 ± 4.855), t(20.504) = -2.019, p = 0.049. This was not significant among income earning WLHIV. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05639-z.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, 2 Koret Way, Suite N431G, San Francisco, CA, USA.
| | - Pascal Agbadi
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, and Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Geoffrey Anguyo
- Kigezi Healthcare Foundation, and Mbarara University of Science and Technology, Kabale, Uganda
| | - Carol S Camlin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
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16
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Mukose AD, Bastiaens H, Makumbi F, Buregyeya E, Naigino R, Musinguzi J, Van Geertruyden JP, Wanyenze RK. What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study. PLoS One 2021; 16:e0251181. [PMID: 33951109 PMCID: PMC8099116 DOI: 10.1371/journal.pone.0251181] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda. Methods A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data. Results Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women’s personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15–8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04–1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery. Conclusions Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women’s readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.
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Affiliation(s)
- Aggrey David Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Hilde Bastiaens
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rose Naigino
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Jean-Pierre Van Geertruyden
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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17
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Dada AO, Abubakar A, Bashorun A, Nguku P, Oladimeji A. Predictors of adherence to option B+ approach for the prevention of mother to child transmission of human immunodeficiency virus in Abuja, 2017. Pan Afr Med J 2021; 38:54. [PMID: 33854683 PMCID: PMC8017365 DOI: 10.11604/pamj.2021.38.54.16690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/11/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction option B+ ART is a lifelong regimen of ART using a combination of 3 ARVs and adherence to this regimen can reduce risk of MTCT to 1-2% as against 15-40% without treatment. To achieve an undetectable viral load and prevent the development of drug resistance, a person on ARV drugs need to take at least 95% of prescribed doses on time. This study assessed the level of adherence to Option B+ PMTCT program and its predictors among HIV+ Pregnant women accessing antenatal care in health facilities Abuja. Methods we enrolled 284 HIV positive pregnant women and lactating mothers in a hospital-based cross-sectional study. We sampled respondents using two-staged sampling technique. We collected data on socio-demographic characteristics, level of adherence, patients and healthcare related factors affecting adherence, knowledge of clients on HIV, ART and MTCT. Focused group discussion guide, data abstraction form and key informant interview guide were used for PMTCT focal persons. We conducted bivariate analysis and logistic regression using Epi-Info version 7 at 5% level of significance. Results the mean age of respondents was 30.12 years (SD±4.86) with mean knowledge score of 16.7 and 75.5%% of them had good knowledge. The level of good adherence was 83.3%. Independent factors associated with non-adherence to ART included: Forgetfulness (OR 20.02; 95% CI 6.42-62.48), having side effects (OR 39.6; 95% C.I: 4.46-352.32), lack of food (OR 34.76; 95% C.I: 2.37-509.33), disclosure of HIV status (OR 2.51; 95% CI 1.22-5.15), being too busy (OR 13.96; 95% CI 3.89-49.98). Encountering challenge in ART initiation (OR 2.05; 95% CI 1.01-4.72) and level of Knowledge (OR 2.12; 95% CI 1.06-5.42). Conclusion the level of adherence would improve study if the Public health department of Federal Ministry of Health (FMOH), Federal Capital Development Authority (FCDA) and National Agency for the Control of AIDS (NACA) sponsors public enlightenment on HIV/AIDS through the media which may help reduce stigma and encourage voluntary HIV status disclosure. Reminders should be used by patients to help them overcome forgetfulness.
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Affiliation(s)
| | | | - Adebobola Bashorun
- Nigeria Field Epidemiology and Laboratory Training Program Abuja, Abuja, Nigeria
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Program Abuja, Abuja, Nigeria
| | - Abisola Oladimeji
- Nigeria Field Epidemiology and Laboratory Training Program Abuja, Abuja, Nigeria
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18
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Mbeya Munkhondya TE, Smyth RMD, Lavender T. Facilitators and barriers to retention in care under universal antiretroviral therapy (Option B+) for the Prevention of Mother to Child Transmission of HIV (PMTCT): A narrative review. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Tsegaye R, Etafa W, Wakuma B, Mosisa G, Mulisa D, Tolossa T. The magnitude of adherence to option B plus program and associated factors among women in eastern African countries: a systematic review and meta-analysis. BMC Public Health 2020; 20:1812. [PMID: 33246437 PMCID: PMC7693523 DOI: 10.1186/s12889-020-09903-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Despite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers’ adherence to option B plus is still a challenge. Though few primary studies are available on the magnitude of adherence to option B plus and factors associated in Eastern African countries, they do not provide strong evidence in helping policymakers to address suboptimal adherence to option B plus. Therefore, this systematic review and meta-analysis was intended to estimate the pooled magnitude of adherence to option B plus program and associated factors among women in Eastern African countries. Methods PubMed, Medline, HINARI, Cochrane library, the Web of Science, and Google Scholar were searched for studies reported on the magnitude of adherence to option B plus among women in Eastern African countries. The search terms used were “option B plus”, “magnitude”, “prevalence”, “PMTCT”, “ART adherence”, “associated factors”, “all lists of Eastern African countries” and their combination by Boolean operators. The effect sizes of the meta-analysis were the magnitude of adherence to option B plus and the odds ratio of the associated factors. STATA/SE V14 was used for statistical analysis, and publication bias was assessed using funnel plots and Egger’s test. Results Fourteen studies having total participants of 4883 were included in the systematic review and meta-analysis. Using the random effect model, the pooled prevalence of adherence to option B plus was 71.88% (95% CI: 58.54–85.23%). The factors associated with good adherence to option B plus PMTCT program were partner support (Adjusted odds ratio (AOR) = 4.13; 95% CI: 2.78–6.15), received counseling services (AOR = 4.12, 95% CI: 2.81–6.02), disclosure of HIV status to partner (AOR = 4.38; 95% CI: 1.79–10.70), and clinical stage of HIV/AIDS I/II (AOR = 2.62; 95% CI: 1.53–4.46). Conclusion The level of adherence to option B plus program in Eastern African countries was generally sub-optimal. Thus, a coordinated effort is needed to raise the number of mothers to be tested, and early treatment initiation for HIV positive mothers before the disease advances. Furthermore, counseling services for couples on the importance of early treatment initiation and adherence to medications must be given due attention.
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Affiliation(s)
- Reta Tsegaye
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Werku Etafa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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20
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HIV-Positive Status Disclosure and Associated Factors among HIV-Positive Adult Patients Attending Art Clinics at Public Health Facilities of Butajira Town, Southern Ethiopia. AIDS Res Treat 2020; 2020:7165423. [PMID: 33204528 PMCID: PMC7665937 DOI: 10.1155/2020/7165423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/18/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Human immunodeficiency virus-positive status disclosure is the process of informing one's HIV-positive status to others. It is the base for accessing care and treatment programs, attaining psychosocial support, reducing stigma, adhering to treatment, and promoting safer health. Even though different strategies were done in Ethiopia to increase the magnitude of HIV status disclosure among HIV-positive patients, the magnitude is still low. The magnitude of HIV-positive status disclosure was not assessed yet after initiation of the new strategy (test and treat strategy). The aim of this study is to assess the magnitude and factors associated with HIV-positive status disclosure among HIV-positive adults attending antiretroviral therapy clinic at the public health facilities of Butajira town. Methods Institution-based cross-sectional study was conducted at public health facilities of Butajira town. A total of 414 study participants were selected by systematic random sampling technique. Data were collected by using pretested interviewer-administered semistructured questionnaire. The collected data were entered into EpiData3.1 and exported to SPSS version 23. Bivariate and multivariable logistic regression analysis was used to identify factors associated with HIV-positive status disclosure. The strength of association was assessed by crude odds ratio and adjusted odds ratio for bivariate and multivariable logistic regression analysis, respectively. Statistically significance was declared at p value <0.05 and 95% CI. Results The magnitude of HIV-positive status disclosure was 90%. Discussing about safer sex (AOR: 3.5; 95% CI: 1.3, 9.4), viral load suppression (AOR: 4; 95% CI: 1.5, 10.1), having good ART adherence (AOR: 6; 95% CI: 2.4, 14.0), receiving counseling (AOR: 2.5; 95% CI: 1.01, 6.3), and perceiving stigma (AOR: 0.25; 95% CI: 0.09, 0.60) were the independent factors associated with HIV-positive status disclosure. Conclusion Although the majority of the participants (90%) of them disclosed their HIV-positive status, lack of disclosure by few people can tackle HIV prevention and control programs. Health programs could improve disclosure of HIV-positive status by providing counseling service, strengthening adherence of antiretroviral therapy, suppressing viral load, and avoiding (reducing) stigma on HIV-positive patients by their community.
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Gebretsadik GG, Gebretnsae H, Ftwi M, Tesfahunegn A. Alarm Clock-Based Reminder for Improving Low Adherence on Option B Plus Antiretroviral Therapy Among HIV Positive Pregnant and Lactating Mothers in Northern Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:687-695. [PMID: 33177885 PMCID: PMC7652568 DOI: 10.2147/hiv.s261420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022]
Abstract
Background Option B plus antiretroviral therapy (ART) is an approach used to eliminate new Human Immune Deficiency Virus (HIV) infections among infants. Considering the high adherence on Option B plus ART in HIV positive mothers is a crucial part in preventing mother-to-child transmission HIV. Therefore, this study was performed to assess the status of adherence and factors related to Option B plus ART. Methods A cross-sectional study design was conducted in Eastern zone of Tigrai Region from January to February 2017. Data were collected by using pre-tested structured interviewer-administered questionnaire from 350 participants selected using simple random sampling. Descriptive and binary logistic regression was done during analysis. Results The overall good adherence status of Option B plus ART among pregnant and lactating mothers was 67.3% [62.3–72.3%]. Attending formal education (AOR=2.78, 95% CI 1.52–5.07), traveling for <1 hour to reach health facility (AOR=2.03, 95% CI 1.19–3.44), (CD4) count <350 cells/mm3 (AOR=2.3, 95% CI 1.33–3.95), starting their Option B plus during pregnancy (AOR= 2.08, 95% CI 1.08–3.97), taking one pill per day (AOR=2.12, 95% CI 1.25–3.58), using a clock as a reminder (AOR=2.51, 95% CI 1.3–4.86), and having good male involvement (AOR=2.91, 95% CI 1.64–5.16) were associated with good level of adherence for Option B plus ART treatment. Conclusion Our study revealed that the level of good adherence is low compared with the national target. Therefore, addressing the low adherence of Option B plus ART requires a policy response, such as efforts to enhance male partner involvement and better service accessibility in Prevention of Mother-to-Child Transmission (PMTCT) program. Moreover, health care providers and policymakers need to maximaze their efforts on HIV positive pregnant and lactating mothers using a clock as a reminder.
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Affiliation(s)
| | | | - Mulu Ftwi
- Department of Midwifery, College of Health Science, Adigrat University, Adigrat, Tigray, Ethiopia
| | - Afewerki Tesfahunegn
- Department of Epidemiology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
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Fedlu A, Alie B, Siraj Mohammed A, Adem F, Hassen A. Adherence to Antiretroviral Treatment for Prevention of Mother-to-Child Transmission of HIV in Eastern Ethiopia: A Cross-Sectional Study. HIV AIDS (Auckl) 2020; 12:725-733. [PMID: 33204173 PMCID: PMC7666997 DOI: 10.2147/hiv.s274012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Even though PMTCT (prevention of mother-to-child transmission) is the most effective option to prevent vertical transmission of HIV, achieving optimal adherence has been a universal challenge to PMTCT, including Ethiopia. OBJECTIVE To assess levels of adherence and associated factors among pregnant and lactating mothers on PMTCT at public health facilities in Harar town, Harari region, Eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted from April 01 to April 30, 2019, at the selected public health facilities of Harar town, Harari regional state, Eastern Ethiopia. Adherence was measured using a multi-method tool that includes pill counting and self-reporting method. Binary logistic regression analysis was used to determine factors associated with PMTCT adherence. The results were adjusted for possible confounding variables and P-value <0.05 or CI not including 1 was considered statistically significant. RESULTS Of the 190 included patients, 83.2% of them had good adherence to PMTCT. Forgetfulness (79%) and being busy (71%) were among the main reasons for non-adherence to PMTCT. In multivariate logistic regression, participants who have received counseling on side effects were 3.4 times more likely to have good adherence [AOR=3.4, 95% CI: 2.1-9.2]; those with previously known HIV status were 2.1 times more likely to have good adherence to PMTCT [AOR=2.1, 95% CI: 1.6-7.1] and women who were knowledgeable on PMTCT were 5.2 times more likely to have good adherence [AOR=5.2, 95% CI: 1.6-6.28]. CONCLUSION In this study, the overall level of adherence to PMTCT care and support was 83.2%. Counseling on side effects, knowledge about PMTCT, and pregnancy status during initiation of ART were the factors that determine adherence of pregnant and lactating women towards PMTCT service. Thus, it is recommended to raise awareness about PMTCT among all reproductive-age women by stressing the benefit of the early initiation of ART and by providing information on the possible side effect of the drugs.
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Affiliation(s)
- Anwar Fedlu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Birhanu Alie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ammas Siraj Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abduselam Hassen
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Wondimu F, Yetwale F, Admassu E, Binu W, Bulto GA, Lake G, Girmaye E, Temesgen K, Marama T. <p>Adherence to Option B<sup>+</sup> Care for the Prevention of Mother-to-Child Transmission Among Pregnant Women in Ethiopia</p>. HIV AIDS (Auckl) 2020; 12:769-778. [PMID: 33239922 PMCID: PMC7682779 DOI: 10.2147/hiv.s282463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/10/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Even if progressive efforts were made in Ethiopia, half of new HIV infections result from mother-to-child transmission. Limited studies assessed the level and factors of adherence that differ among different populations across the country. So, this study aimed to investigate the level and predictors of adherence to the prevention of mother-to-child transmission (PMTCT) Option B+ care among pregnant women in central Ethiopia. Methods A facility-based cross-sectional study design was conducted to interview 347 HIV positive pregnant women. Using a multistage sampling technique, participants were recruited from twelve health facilities based on probability proportional to the number of clients. The collected data on socio-demographics, healthcare delivery, clinical and individual factors were entered into EpiInfo v7.2.2.6, and further analysis was done using SPSS v23 software. Adherence was measured based on client self-report either as adherent and non-adherent. Bivariate and multivariate logistic regressions were undertaken to see the association between variables. Statistically significant variables were declared using an adjusted odds ratio with a 95% confidence interval. Results The overall adherence to option B+ was 80.2% (95% CI: 76.3–84.5%). Time of ART initiation (AOR=3.23; 95% CI: 1.09–6.59), fear of stigma for taking ARV (AOR=5.06; 95% CI: 1.79–10.26), ANC appointment (AOR=4.62; 95% CI: 1.48–6.42), male partner support (AOR=2.23; 95% CI: 1.11–4.50), and counseling (AOR=5.36: 95% CI: 1.00–8.58) were the associated factors with level of adherence. Conclusion The overall adherence level to Option B+ care in this study was inadequate to suppress the viral load during pregnancy. The result revealed that keeping adherence to ARVs during pregnancy is still challenging. So, all concerned bodies need to give attention to minimize the barriers from the client, environment, and health system perspectives.
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Affiliation(s)
- Fikadu Wondimu
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Fisseha Yetwale
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endashew Admassu
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wakgari Binu
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- Correspondence: Wakgari Binu School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, P.o. Box: 138, Wolaita Sodo, EthiopiaTel +251 910107704 Email
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Getie Lake
- School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eden Girmaye
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Kababa Temesgen
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Taklu Marama
- Department of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Yeshialem Asefa E, Edosa Dirirsa D. <p>Level of Good Adherence on Option B+ PMTCT and Associated Factors Among HIV Positive Pregnant and Lactating Mothers in Public Health Facilities of Ilu Abba Bor and Buno Bedele Zones, Oromia Regional State, Southwestern Ethiopia, 2018</p>. HIV AIDS (Auckl) 2020; 12:789-798. [PMID: 33273864 PMCID: PMC7708262 DOI: 10.2147/hiv.s283184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background PMTCT programs help safe delivery practices and recommended infant feeding, as well as providing ART for infants exposed to HIV after birth for prevention and effective treatment. PMTCT service helps to reduce about 1.4 million HIV infections among children between 2010 and 2018. This study aimed to assess the good adherence level and associated factors of option B+ PMTCT among HIV-positive pregnant and lactating women in public health facilities of Ilu Abba Bor and Buno Bedele zones, Oromia regional state, Southwestern Ethiopia 2018. Methodology Institutional-based cross-sectional study design was implemented to investigate the level of good adherence to option B+ PMTCT and possible predictors. A simple random sampling technique was used to interview a total of 180 mothers using the interviewer-guided questionnaire for data collection. Data were entered into EpiData version 3.1 and analyzed by SPSS version 23.0 statistical software. Descriptive statistics and logistic regression were computed to identify and see the relative effect of predictors on the outcome variable. Results In this study, 146 (81.1%) of the study participants had good adherence to PMTCT option B+. Women who received social and financial support from friends, family members, and partners had good adherence to PMTCT option B+ than their counterparts. Similarly, women who disclosed their HIV status to others had good adherence than those who did not expose their status to their friends and parents. Conclusion and Recommendation This study identified the overall level of PMTCT option B+ adherence level in the study area to be good compared to the national and some other findings. Providing support and encouraging a woman for disclosing their HV status for partners and families are very important to increase the adherence level of option B+.
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Affiliation(s)
- Eyosiyas Yeshialem Asefa
- Department of Midwifery, College of Health Science, Debre Birhan University, Debre Birhan, Ethiopia
- Correspondence: Eyosiyas Yeshialem Asefa Email
| | - Dejene Edosa Dirirsa
- Department of Midwifery, Public Health, and Medical Science Faculty, Mettu University, Mettu, Ethiopia
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Nutor JJ, Slaughter-Acey JC, Afulani PA, Obimbo MM, Mojola SA. The Relationship Between Counseling and Adherence to Antiretroviral Therapy Among Pregnant and Breastfeeding Women Enrolled in Option B. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:378-391. [PMID: 33112676 DOI: 10.1521/aeap.2020.32.5.378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of the study was to investigate the relationship between counseling prior to starting antiretroviral treatment (ART) and adherence to treatment among women enrolled in Option B+ in Zambia. Using convenience sampling, 150 HIV+ women enrolled in an Option B+ treatment regimen in rural and urban districts were recruited. Four generalized Poisson regression models were built to assess the association between counseling and adherence to ART. In all, 75% of the participants reported adherence in the past 7 days. In adjusted analyses, there was a significant positive relationship between counseling and adherence in the rural district (prevalence ratio [PR] 2.52, 95% CI [1.19, 5.35], n = 81) but not in the urban district (PR = 0.77, 95% CI [0.15, 3.91], n = 69). Offering counseling prior to initiating antiretroviral treatment to HIV+ women is particularly important for promoting medication adherence in rural settings of low resourced countries.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, California
| | - Jaime C Slaughter-Acey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Patience A Afulani
- Departments Epidemiology & Biostatistics and Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco
| | - Moses M Obimbo
- Departments of Human Anatomy and Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Sanyu A Mojola
- Department of Sociology, Woodrow Wilson School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, New Jersey
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Nutor JJ, Slaughter-Acey JC, Marquez SP, DiMaria-Ghalili RA, Momplaisir F, Oladimeji KE, Jemmott LS. Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia. BMC Public Health 2020; 20:1410. [PMID: 32938415 PMCID: PMC7495861 DOI: 10.1186/s12889-020-09505-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia. METHODS We recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART. RESULTS Intention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67-0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76-0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality. CONCLUSION Compared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course.
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Affiliation(s)
- Jerry John Nutor
- Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA, 94143-0608, USA.
| | - Jaime C Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Shannon P Marquez
- Undergraduate Global Engagement, Columbia University, New York City, NY, 110027, USA
| | | | - Florence Momplaisir
- Department of Medicine, Hospital of University of the Pennsylvania, Philadelphia, PA, 19102, USA
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, Alice, Eastern Cape, South Africa
| | - Loretta S Jemmott
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, 19104, USA
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Nutor JJ, Slaughter-Acey JC, Marquez SP, DiMaria-Ghalili RA, Momplaisir F, Jemmott LS. Influence of toilet access on antiretroviral adherence intention among pregnant and breastfeeding women who are HIV-positive and enrolled in Option B. Health Care Women Int 2020; 42:261-275. [PMID: 32238109 DOI: 10.1080/07399332.2020.1746791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We investigated the influence of toilet access on intention to adhere to antiretroviral therapy (ART) among women who are HIV-positive and enrolled in Option B+. A convenience sample of 150 women residing in Lusaka (urban) and Sinazongwe (rural) Districts of Zambia were recruited. if they were seeking pre- or post-natal care and were enrolled in Option B+. Intention to adhere to ART was assessed using four questions based on the Theory of Planned Behavior; the median score was used to distinguish high intention from low intention. Descriptive statistics were used to characterize access to toilet facilities and ART adherence intention in the entire sample and by rural and urban districts in Zambia. There was no significant difference (p = .19) between rural and urban women's access to a flush toilet. After adjusting for toilet access, however, rural women were significantly less likely to be in the high adherence intention group (PR = 0.80, 95% CI 0.71-0.90, p < .001) but access to a flush toilet was associated with adherence intention (PR = 1.14, 95% CI (1.00 - 1.30). Community-led total sanitation in Zambia could increase ART adherence intention.
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Affiliation(s)
- Jerry John Nutor
- Family Health Care Nursing Department, School of Nursing, University of California, San Francisco, California, USA
| | - Jaime C Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shannon P Marquez
- Undergraduate Global Engagement, Columbia University, New York City, New York, USA
| | | | | | - Loretta S Jemmott
- College of Nursing and, Health Professions Drexel University, Philadelphia, Pennsylvania, USA
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Brittain K, Mellins CA, Remien RH, Phillips TK, Zerbe A, Abrams EJ, Myer L. Impact of HIV-Status Disclosure on HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2020; 81:379-386. [PMID: 30939530 DOI: 10.1097/qai.0000000000002036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND HIV-status disclosure is widely encouraged by counseling services, in part because it is thought to improve antiretroviral therapy (ART) adherence and thus HIV viral suppression. However, few longitudinal studies have examined the impact of disclosure on HIV viral load (VL) during pregnancy and postpartum. METHODS We explored these associations among 1187 women living with HIV, enrolled between March 2013 and June 2014 in Cape Town, South Africa. RESULTS Among women who tested HIV-positive before pregnancy, we observed no association between disclosure and VL at entry into antenatal care among those already on ART, nor at delivery and 12 months postpartum among those initiating ART. Among women who tested HIV-positive during pregnancy and initiated ART subsequently, disclosure to a male partner was associated with a reduced risk of VL ≥50 copies/mL at delivery (adjusted risk ratio: 0.56; 95% confidence interval: 0.31 to 1.01). After stratification by relationship status, this association was only observed among women who were married and/or cohabiting. In addition, disclosure to ≥1 family/community member was associated with a reduced risk of VL ≥50 copies/mL at 12 months postpartum (adjusted risk ratio: 0.69; 95% confidence interval: 0.48 to 0.97) among newly-diagnosed women. CONCLUSIONS These findings suggest that the impact of disclosure on VL is modified by 3 factors: (1) timing of HIV diagnosis (before vs. during the pregnancy); (2) relationship to the person(s) to whom women disclose; and (3) in the case of disclosure to a male partner, relationship status. Counseling about disclosure may be most effective if tailored to individual women's circumstances.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, New York, NY
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP at Columbia University, New York, NY.,Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abebe AM, Kassaw MW, Shewangashaw NE. Level of Knowledge About Prevention of Mother-to-Child Transmission of HIV Option B+ and Associated Factors Among ANC Clients in Kombolcha Town, South Wollo Amhara Regional State, Ethiopia, 2017. HIV AIDS (Auckl) 2020; 12:79-86. [PMID: 32110115 PMCID: PMC7037140 DOI: 10.2147/hiv.s242166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the level of knowledge about prevention of mother-to-child transmission option B+ and associated factors among antenatal care clients in Kombolcha town; 2017. METHODS An institutional-based cross-sectional study design was conducted from May 1 to 30, 2017. Simple random sampling techniques were used to select 129 study subjects from May 1 to 30, 2017. A chi-square test was done by using SPSS 20 to assess the association between the dependent and independent variables. Frequency tables, pie chart, and graphs were used to present the findings of the study. RESULTS Among the total study participants, 61% had adequate knowledge about prevention of mother-to-child transmission Option B+. This study found a strong positive association between knowledge of prevention of mother-to-child transmission B+ option and age, educational status, occupational status, number of ANC follow-up visits for the current pregnancy and number of parity. CONCLUSION This study showed more than half of these study participants had adequate knowledge about the prevention of mother-to-child transmission B+ option. Age, educational status, employment, parity and number of antenatal care visits had a statistically significant association with pregnant womens' knowledge of prevention of mother-to-child transmission B+ option. Therefore, it is better to design to give health education on prevention of mother-to-child transmission B+ option particularly for older age, uneducated, unemployed, partiy of one pregnant women.
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Affiliation(s)
- Ayele Mamo Abebe
- Department of Nursing, Debre Berhan University, Amhara, Ethiopia
| | - Mesfin Wudu Kassaw
- Department of Nursing, College of Health Sciences, Woldia University, Amhara, Ethiopia
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Tolossa T, Kassa GM, Chanie H, Abajobir A, Mulisa D. Incidence and predictors of lost to follow-up among women under Option B+ PMTCT program in western Ethiopia: a retrospective follow-up study. BMC Res Notes 2020; 13:18. [PMID: 31910888 PMCID: PMC6947837 DOI: 10.1186/s13104-019-4882-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/28/2019] [Indexed: 12/04/2022] Open
Abstract
Objective Although Ethiopia has been implementing Option B+ program, LTFU of women from the Option B+ program is one of the challenges that minimizes its implementation. Thus, this study assessed the incidence and predictors of LTFU among women under Option B+ PMTCT program in western Ethiopia. An institution-based retrospective follow-up study was conducted. A cox proportional hazards regression model was fitted to identify predictors of LTFU. A Hazard ratios with 95% confidence CI was computed and all predictors that were associated with the outcome variable at p-value ≤ 0.05 in the multivariable cox proportional hazards were declared as a significance predictor of the outcome. Results A total of 330 women were followed for a mean follow up time of 16.9 (± 7.6) months. An overall incidence rate of LTFU was 9/1000 person-months. Women’s educational status, residence, HIV-disclosure status, the status of women at enrollment, previous history of HIV and ART adherence were significant predictors of LTFU. The incidence of LTFU from Option B+ PMTCT is lower as compared to evidence from sub-Saharan African and strengthening linkage and referral system between clinics as well as establishing appropriates tracing mechanisms would retain pregnant women in the program.
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Affiliation(s)
- Tadesse Tolossa
- Department of Public Health, Institute of Health Science, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia.
| | - Getachew Mullu Kassa
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Chanie
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Amanuel Abajobir
- Maternal and Child Wellbeing Unit, African Population and Health Research Centre, Nairobi, Kenya
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Science, Wollega University, Nekemte, Ethiopia
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Tarekegn M, Baru A, Seme A. Levels of option B+ ART drugs adherence and associated factors among pregnant women following ART services at public health facilities of East Shawa Zone, Oromia, Ethiopia. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 22:100459. [PMID: 31442747 DOI: 10.1016/j.srhc.2019.100459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/12/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Anti-retroviral therapy has led to a significant reduction in morbidity and mortality related to HIV/AIDS. However, this cannot be fully realized without addressing the barriers related to retention in care and medication adherence. METHODS A cross-sectional study design was implemented to select 293 pregnant women on option B+ anti-retroviral treatment (ART). The collected data was cleaned and entered into Epidata version 3.1 and exported to SPSS Version 21 for analysis. Multiple logistic regression models were used to indicate the association between variables. RESULTS The overall drug adherence of pregnant women on ART medications was 82.6%. The study showed that participants educational status, AOR 4.54(95% CI; 1.72-11.95), participants status disclosure 2.61(95% CI; 1.01-6.71), social and financial support to the participants AOR 2.76(95% CI; 1.17-6.51), counseling on the benefit AOR 2.9(95% CI; 1.27-6.63), were all positive and significantly associated with adherence to option B + treatment, while experience of drug side effect AOR 0.24(95% CI; 0.1-0.6), and fear of stigma and discrimination AOR 15.79(95% CI; 4.64-53.67), were negatively associated with adherence to option B+ treatment. CONCLUSION Educational status, counseling on the health benefit of treatment for the fetus and the mothers, social and financial support favors adherence while fear of stigma and discrimination and drug side effects negatively affect adherence to option B+. The study calls for collaborative work among patients, healthcare professionals, and the public to enhance ART adherence.
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Affiliation(s)
| | - Ararso Baru
- Arbaminch University College of Health Science, Slums and Rural Health Initiative Network (SRHIN), Arbaminch, Ethiopia.
| | - Assefa Seme
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
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van Lettow M, Cataldo F, Landes M, Kasende F, Nkhoma P, van Oosterhout JJ, Kim E, Schouten E, Nkhoma E, Nyirenda R, Tippett Barr BA. Impact of inter-partner HIV disclosure patterns in Malawi's PMTCT program: A mixed-method study. PLoS One 2019; 14:e0219967. [PMID: 31348782 PMCID: PMC6660128 DOI: 10.1371/journal.pone.0219967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/06/2019] [Indexed: 11/19/2022] Open
Abstract
Background Evidence suggests that disclosure of HIV status between partners may influence prevention of maternal-to-child transmission of HIV (PMTCT) outcomes. We report partner disclosure in relation to maternal antiretroviral therapy (ART) uptake and adherence, and MTCT among postpartum HIV-infected Malawian women. Methods A cross-sectional mixed-method study was conducted as part of a nationally representative longitudinal cohort study. Between 2014–2016, all (34,637) mothers attending 54 under-5 clinics with their 4–26 week-old infants were approached, of which 98% (33,980) were screened for HIV; infants received HIV-1 DNA testing. HIV-exposure was confirmed in 3,566/33,980 (10.5%). Baseline data from mothers who were known to be HIV-infected at time of screening were included in the current analysis. Guardians (n = 17), newly diagnosed HIV-infected mothers (n = 256) and mothers or infants with undetermined HIV status (n = 30) were excluded. Data collected included socio-demographics, partner disclosure, maternal ART uptake, and adherence. Between 2016–2017, in-depth interviews and focus group discussions were conducted with adult mothers (n = 53) and their spouse/cohabiting partners (n = 19), adolescent mothers (n = 13), lost-to-follow up (LTFU) mothers (n = 22), community leaders (n = 23) and healthcare workers (n = 154). Results Of 3153 known HIV-infected mothers, 2882 (91.4%) reported having a spouse/cohabiting partner. Among 2882 couples, both partners, one partner, and neither partner disclosed to each other in 2090 (72.5%), 622 (21.6%), and 169 (5.9%), respectively. In multivariable models, neither partner disclosing was associated with no maternal ART (aOR 4.7; 95%CI 2.5–8.8), suboptimal treatment adherence (aOR 1.8; 95%CI 1.1–2.8) and MTCT (aOR 2.1; 95%CI 1.1–4.1). Women’s fear of blame by partners was central to decisions not to disclose within couples and when starting new relationships. LTFU mothers struggled to accept and disclose their status, hindering treatment initiation; some were unable to hide ART and feared involuntary disclosure. Conclusion Partner disclosure seems to play an important role in women’s decisions regarding ART initiation and adherence. Inter-partner non-disclosure was associated with no ART uptake, suboptimal treatment adherence and MTCT.
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Affiliation(s)
- Monique van Lettow
- Medical and Research Department, Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail: ,
| | - Fabian Cataldo
- Medical and Research Department, Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Megan Landes
- Medical and Research Department, Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Florence Kasende
- Medical and Research Department, Dignitas International, Zomba, Malawi
| | - Pearson Nkhoma
- Medical and Research Department, Dignitas International, Zomba, Malawi
| | - Joep J. van Oosterhout
- Medical and Research Department, Dignitas International, Zomba, Malawi
- Department of Medicine, College of Medicine University of Malawi, Blantyre, Malawi
| | - Evelyn Kim
- United States Centers for Disease Control and Prevention, Lilongwe, Malawi
| | | | | | | | - Beth A. Tippett Barr
- Department of Medicine, College of Medicine University of Malawi, Blantyre, Malawi
- United States Centers for Disease Control and Prevention, Kisumu, Kenya
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Phillips TK, Myer L. Shifting to the long view: engagement of pregnant and postpartum women living with HIV in lifelong antiretroviral therapy services. Expert Rev Anti Infect Ther 2019; 17:349-361. [PMID: 30978126 DOI: 10.1080/14787210.2019.1607296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The advent of policies promoting lifelong antiretroviral therapy (ART) for all pregnant and postpartum women living with HIV has shifted focus from short-term prevention of mother-to-child transmission (PMTCT) to lifelong engagement in ART services. However, disengagement from care threatens the long-term treatment and prevention benefits of lifelong ART. Areas covered: A framework for considering the unique aspects of ART for pregnant and postpartum women is presented along with a review of the literature on maternal engagement in care in sub-Saharan Africa and a discussion of potential interventions to sustain engagement in lifelong ART. Expert opinion: Engaging women and mothers in ART services for life is critical for maternal health, PMTCT, and prevention of sexual transmission. Evidence-based interventions exist to support engagement in care but most focus on periods of mother-to-child transmission risk. In the long term, life transitions and health-care transfers are inevitable. Thus, interventions that can reach beyond a single facility or provide a bridge between health services should be prioritized. Multicomponent interventions will also be essential to address the numerous intersecting barriers to sustained engagement in ART services.
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Affiliation(s)
- Tamsin K Phillips
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- a Division of Epidemiology & Biostatistics and Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
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Option B plus antiretroviral therapy adherence and associated factors among HIV positive pregnant women in Southern Ethiopia. BMC Pregnancy Childbirth 2019; 19:82. [PMID: 30819147 PMCID: PMC6394094 DOI: 10.1186/s12884-019-2228-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background Adherence to Option B plus Antiretroviral Therapy plays a vital role in preventing mother to child transmission of Human Immunodeficiency Virus and development of drug resistance. This study was aimed to assess adherence to option B plus ART and associated factors among HIV positive pregnant women at public Hospitals in Southern Ethiopia. Methods Facility based cross sectional study was conducted on HIV positive pregnant mothers attending public health facilities’ antenatal care unit. Systematic random sampling technique was employed to select 290 HIV positive pregnant women enrolled in the Option B plus program. Data were collected by using structured questionnaire. Bivariate and multivariable logistic regression analysis were used to identify factors associated with option B plus ART adherence. P-value less than 0.05 was considered as cut of point to declare statistical significance. Results The overall adherence to option B plus ART among HIV positive pregnant women was 236 (81.4%). Three in twenty, (14.8%) participants were none adherent to Option B plus ART due to difficulty in adopting time schedule and forgetting to take medication. During first trimester of pregnancy, 16 (5.5%) were stopped taking ART medication due to side effects. Pregnant women who started ART at the time of HIV diagnosis [AOR = 1.99, 95% CI: (1.02, 3.95)], and who had five or more antenatal care visits [AOR = 4.10, 95% CI (1.65, 10.02)] were more likely to adhere to option B plus ART. Women who should travel 30–60 min on foot to access ART from service delivering facilities were less likely to adhere to option B plus [AOR = 0.39, 95% C I: (0.17, 0.88)]. Conclusions The overall adherence to option B plus ART was suboptimal. Measures that improve recalling ability of individuals to take ART on time, and minimize ART side effects during first trimester of pregnancy need to be given emphasis. The study finding indicates the need for reconsidering the ad-hoc focused antenatal care visit at policy and program level by increasing the number of follow up visit with proper counseling on ART adherence benefits, and improving service accessibility.
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Zacharius KM, Basinda N, Marwa K, Mtui EH, Kalolo A, Kapesa A. Low adherence to Option B+ antiretroviral therapy among pregnant women and lactating mothers in eastern Tanzania. PLoS One 2019; 14:e0212587. [PMID: 30794633 PMCID: PMC6386496 DOI: 10.1371/journal.pone.0212587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background Adherence to option B+ antiretroviral treatment (ART) is vital to a successful implementation of Prevention of Mother to Child Transmission (PMTCT) program. Further studies show that optimal viral suppression is also crucial for a successful PMTCT program, however barriers to adherence exist and differ among populations and particularly within few years of its adoption in Tanzania. This study therefore aimed at investigating the level and predictors of adherence to ART option B+ among pregnant and lactating women in rural and urban settings of eastern Tanzania. Methodology A cross-sectional study was conducted among 305 pregnant women and lactating mothers on Option B+ regime from six health facilities located in rural and urban settings in Morogoro region in eastern Tanzania. Data were collected using a structured questionnaire. Data analysis was performed using descriptive statistics, as well as bivariate and multivariate logistic regression. Results Good adherence to option B+ PMTCT drugs was 26.3% and 61.1% among respondents residing in urban and rural areas respectively. The rural residents were 4.86 times more likely to adhere compared to their counterparts in an urban area (aOR = 4.86; 95% CI = 2.91–8.13). Similarly, women with male partners’ support in PMTCT were 3.51 times more likely to have good adherence than those without (aOR = 3.51, 95% CI = 1.21–10.15). Moreover, there was a significantly lower odds of adherence to option B+ among those who had been on treatment between one to two years as compared to those had less than one year of treatment (aOR = 0.45; 95%CI = 0.22–0.93). Conclusion Adherence to PMTCT option B+ antiretroviral drugs treatment among pregnant women and breastfeeding mothers was low and much lower among urban residents. Adherence was significantly predicted by rural residence, male partner support and short duration on ART. Efforts to improve adherence should focus on increasing male participation on PMTCT, tailored interventions to urban residents and those who have been on ART for a long duration.
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Affiliation(s)
| | - Namanya Basinda
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Karol Marwa
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Emmanuel H. Mtui
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Albino Kalolo
- Department of Community Medicine, St. Francis University of Health and Allied Sciences, Ifakara, Tanzania
| | - Anthony Kapesa
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- * E-mail:
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Omonaiye O, Kusljic S, Nicholson P, Mohebbi M, Manias E. Post Option B+ implementation programme in Nigeria: Determinants of adherence of antiretroviral therapy among pregnant women with HIV. Int J Infect Dis 2019; 81:225-230. [PMID: 30790723 DOI: 10.1016/j.ijid.2019.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Nigeria has the highest rate of mother to child transmission of HIV (MTCT) in the world. By 2015, all Global Plan priority countries, except Nigeria, had adopted the Option B+ programme. Nigeria finally adopted Option B+ in 2016 with full implementation reported in 2017. We examined adherence to antiretroviral therapy (ART) among pregnant women since the rollout of Option B+ in Nigeria. METHODS A cross sectional approach was adopted that involved dissemination of a survey (Adult AIDS Clinical Trial Groups [AACTG] standardised survey) to HIV positive pregnant women, to assess adherence to ART. This study was conducted from February to June, 2018 in four health care sites in Akwa Ibom State, in the South-South region of Nigeria. Bootstrapping was used to estimate the 95% confidence interval of the prevalence of adherence. Bivariate associations between patient demographic characteristics and medication taking behaviours, and the outcome variable of ART adherence were examined using Chi-square tests. Multivariable logistic regression was used to identify factors independently associated with adherence. RESULTS Of the 275 women (response rate=92.6%), 32.7% (95% CI: 26.9-38.5) self-reported taking all ART doses in the past 96 hours. In the multivariable logistic regression analyses, there were positive associations between an increased education level (OR=1.7, p=0.006) and disclosure of HIV status (OR=2.3, p=0.024), and medication adherence. For women who had previous prevention of MTCT exposure, the odds of medication adherence were 2.5 times higher compared with those with no previous MTCT exposure (OR=2.5, p=0.005). CONCLUSION Adherence to ART among pregnant women in Nigeria is low. There is a need to improve adherence during pregnancy under the Option B+ programme in Nigeria.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
| | - Snezana Kusljic
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Pat Nicholson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Mohammadreza Mohebbi
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
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Mulewa P, Satumba E, Mubisi C, Kandiado J, Malenga T, Nyondo-Mipando AL. "I Was Not Told That I Still Have The Virus": Perceptions of Utilization of Option B+ Services at a Health Center in Malawi. J Int Assoc Provid AIDS Care 2019; 18:2325958219870873. [PMID: 31478427 PMCID: PMC6900569 DOI: 10.1177/2325958219870873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/16/2022] Open
Abstract
Utilization of the prevention of mother-to-child transmission of HIV (PMTCT) services remains a challenge as losses to follow-up are substantial. This study explored factors that influence adherence to maternal antiretroviral (ARV) medications among PMTCT mothers in Malawi. We conducted a descriptive qualitative study from September 2016 to May 2017 using purposive sampling among 16 PMTCT mothers and 4 key informant interviews with health-care workers. Data were audio-recorded and analyzed thematically. The factors that influence adherence to maternal ARV medications include the quality of PMTCT services and social support. Factors that impede adherence include suboptimal counseling women receive on ARV medications, cost of travel, and conflicting advice from religious institutions. Adherence to maternal ARV medications will require the use of existing social support systems in a woman's life as a platform for delivery of the drugs while also maintaining continued and comprehensive counseling on the benefits of maternal ARV medications.
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Affiliation(s)
- Patience Mulewa
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Egrina Satumba
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Christopher Mubisi
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Kandiado
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tumaini Malenga
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family
Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Lyatuu GW, Naburi H, Urrio R, Mwashemele SZ, Mdingi S, Panga R, Koda H, Chende Y, Tsere M, Mhalu A, Siril H, Lema IA, Aris E, Muya AN, Galanti MR, Biberfeld G, Kilewo C, Ekström AM. Engaging community leaders to improve male partner participation in the prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania. PLoS One 2018; 13:e0207986. [PMID: 30540794 PMCID: PMC6291081 DOI: 10.1371/journal.pone.0207986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Male partner participation improves uptake, retention and outcomes of prevention of mother-to-child transmission of HIV (PMTCT) services. However, in patriarchal settings few men accompany their partners to antenatal care (ANC) and PMTCT services. We explored whether community leaders can improve male partner participation in ANC and PMTCT. Methods We integrated initiatives to increase male partner participation in routine ANC care in six health facilities (attending about 4,500 new pregnant women per quarter) in Dar es Salaam, Tanzania in 2015/16. These initiatives were adapted from a best performing health facility, on male partner participation in ANC and PMTCT, referred to as the “best practice site”. At the six purposively selected intervention sites, we sensitized and garnered commitment from healthcare providers to provide couple friendly services. We then worked with the providers to sensitize and engage community leaders to integrate and promote male partner participation initiatives in their routine community activities. We assessed change in male partner participation in ANC and PMTCT using the proportion of women testing for HIV together with their partners (i.e. couple HIV testing) by quarter. We used 203 ANC facilities (attending about 31,000 new pregnant women per quarter) in the same area as control sites. Results After one year, couple HIV testing in the six intervention sites had tripled from 11.9% at baseline to 36.0% (p<0.001) while there was very little change (from 17.7% to 18.3%) in the 203 control sites (p = 0.07). Statistically significant improvements in couple testing were observed in four of the six intervention sites (6.7% to 19.1%; 9.3% to 74.6%; 46.2% to 95.2%; and 4.7% to 15.1% respectively. p<0.001 for all sites). Two of these four sites, located in the same administrative district as the best practice site, achieved remarkably high couple HIV testing (95.2% and 74.6%). This may be attributable to the greater engagement and active participation of the community leaders in these two sites compared to the other four. Conclusion Effective engagement and functional partnerships between healthcare providers and community leaders can contribute to improve male partner participation in ANC and PMTCT services. PMTCT programs should capitalize on community leaders, in addressing low male partner participation in ANC and PMTCT, in order to improve effective uptake, retention and outcomes of HIV prevention and treatment services among pregnant and breastfeeding women, their partners, infants and families.
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Affiliation(s)
- Goodluck Willey Lyatuu
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Helga Naburi
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roseline Urrio
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sarah Mdingi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Rehema Panga
- Ubungo Municipal Council, Dar es Salaam, Tanzania
| | - Happiness Koda
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Yusuph Chende
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Martha Tsere
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Aisa Mhalu
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Helen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Eric Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Aisa Nkya Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Gunnel Biberfeld
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Charles Kilewo
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Mia Ekström
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease, Karolinska university hospital, Stockholm, Sweden
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Atanga PN, Ndetan HT, Fon PN, Meriki HD, Muffih TP, Achidi EA, Hoelscher M, Kroidl A. Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B. BMC Pregnancy Childbirth 2018; 18:418. [PMID: 30359239 PMCID: PMC6202832 DOI: 10.1186/s12884-018-2058-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/15/2018] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) adherence in preventing HIV mother-to-child transmission in association with virological suppression and risk factors of low adherence in the Cameroon's Option B+ programme are poorly understood. We used a composite adherence score (CAS) to determine adherence and risk factors of poor adherence in association with virological treatment response in HIV-positive pregnant and breastfeeding women who remained in care at 6 and 12 months after initiating ART. METHODS We prospectively enrolled 268 women after ART initiation between October 2013 and December 2015 from five facilities within the Kumba health district. Adherence at 6 and 12 months were measured using a CAS comprising of a 6-month medication refill record review, a four-item self-reported questionnaires and a 30-day visual analogue scale. Adherence was defined as the sum scores of the three measures and classified as high, moderate and low. Measured adherence levels were compared to virological suppression rates at month 12 and risk factors of poor adherence were determined. RESULTS At 6 and 12 months, 217 (81.0%) and 185 (69.0%) women were available for adherence evaluation. Respectively. Of those, 128 (59.0%) and 68 (31.4%) had high or moderate adherence as per the CAS tool at month 6, and 116 (62.7%) and 48 (24.9%) at month 12, respectively. Viral loads were assessed in 165 women at months 12, and 92.7% had viral suppression (< 1000 copies/mL). Viral suppression was seen in 100% of women with high, 89.5% with moderate, and 52.9% with low adherence using the CAS tool. Virological treatment failure was significantly associated with low adherence [OR 7.6, (95%CI, 1.8-30.8)]. Risk factors for low adherence were younger age [aOR 3.8, (95%CI, 1.4-10.6)], primary as compared to higher levels of education [aOR 2.7, (95%CI, 1.4-5.2)] and employment in the informal sector compared to unemployment [aOR 1.9, (95%CI,1.0-3.6)]. CONCLUSIONS During the first year of Option B+ implementation in Cameroon our novel CAS adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression. Younger age, less educated and informal sector employed women may need more attention for optimal adherence to reduce the risk of virological failure.
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Affiliation(s)
- Pascal N Atanga
- Cameroon Baptist Convention Health Service (CBCHS), P. O. Box 152, Tiko, Health Services Complex, Mutengene, South West Region, Cameroon. .,Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon. .,Centre for International Health (CIH), University of Munich (LMU), Munich, Germany.
| | - Harrison T Ndetan
- Department of Epidemiology and Biostatistics, University Texas Health Northeast, School of Community and Rural Health, Tyler, USA.,Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Peter N Fon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Henry D Meriki
- Department of Microbiology and Parasitology, Faculty of Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.,Laboratory Department, Regional Hospital Buea, Buea, Cameroon
| | - Tih P Muffih
- Cameroon Baptist Convention Health Service (CBCHS), P. O. Box 152, Tiko, Health Services Complex, Mutengene, South West Region, Cameroon
| | - Eric A Achidi
- Faculty of Science, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Michael Hoelscher
- Centre for International Health (CIH), University of Munich (LMU), Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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Kiwanuka G, Kiwanuka N, Muneza F, Nabirye J, Oporia F, Odikro MA, Castelnuovo B, Wanyenze RK. Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study. BMC Infect Dis 2018; 18:533. [PMID: 30355356 PMCID: PMC6201534 DOI: 10.1186/s12879-018-3450-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022] Open
Abstract
Background Lifelong antiretroviral therapy for HIV infected pregnant and lactating women (Option B+) has been rapidly scaled up but there are concerns about poor retention of women initiating treatment. However, facility-based data could underestimate retention in the absence of measures to account for self-transfers to other facilities. We assessed retention-in-care among women on Option B+ in Uganda, using facility data and follow-up to ascertain transfers to other facilities. Methods In a 25-month retrospective cohort analysis of routine program data, women who initiated Option B+ between March 2013 and March 2015 were tracked and interviewed quantitatively and qualitatively (in-depth interviews). Kaplan Meier survival analysis was used to estimate time to loss-to-follow-up (LTFU) while multivariable Cox proportional hazards regression was applied to estimate the adjusted predictors of LTFU, based on facility data. Thematic analysis was done for qualitative data, using MAXQDA 12. Quantitative data were analyzed with STATA® 13. Results A total of 518 records were reviewed. The mean (SD) age was 26.4 (5.5) years, 289 women (55.6%) attended primary school, and 53% (276/518) had not disclosed their HIV status to their partners. At 25 months post-ART initiation, 278 (53.7%) were LTFU based on routine facility data, with mean time to LTFU of 15.6 months. Retention was 60.2 per 1000 months of observation (pmo) (95% CI: 55.9–64.3) at 12, and 46.3/1000pmo (95% CI: 42.0–50.5) at 25 months. Overall, 237 (55%) women were successfully tracked and interviewed and 43/118 (36.4%) of those who were classified as LTFU at facility level had self-transferred to another facility. The true 25 months post-ART initiation retention after tracking was 71.3% (169/237). Women < 25 years, aHR = 1.71 (95% CI: 1.28–2.30); those with no education, aHR = 5.55 (95% CI: 3.11–9.92), and those who had not disclosed their status to their partners, aHR = 1.59 (95% CI: 1.16–2.19) were more likely to be LTFU. Facilitators for Option B+ retention based on qualitative findings were adequate counselling, disclosure, and the desire to stay alive and raise HIV-free children. Drug side effects, inadequate counselling, stigma, and unsupportive spouses, were barriers to retention in care. Conclusions Retention under Option B+ is suboptimal and is under-estimated at health facility level. There is need to institute mechanisms for tracking of women across facilities. Retention could be enhanced through strategies to enhance disclosure to partners, targeting the uneducated, and those < 25 years.
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Affiliation(s)
- George Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O Box 7072, Kampala, Uganda.
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fiston Muneza
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabirye
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Magdalene A Odikro
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Barbara Castelnuovo
- Department of Research, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Omonaiye O, Kusljic S, Nicholson P, Manias E. Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review. BMC Public Health 2018; 18:805. [PMID: 29945601 PMCID: PMC6020364 DOI: 10.1186/s12889-018-5651-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of antiretroviral therapy (ART) is a core strategy proposed by the World Health Organization in preventing mother to child transmission (MTCT) of HIV. This systematic review aimed to examine the enablers and barriers of medication adherence among HIV positive pregnant women in sub-Saharan Africa. METHODS We used the following keywords: HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR "PMTCT Cascade" OR "Vertical Transmission" OR "Mother-to-Child") AND (Prevent OR Prevention) AND (HAART OR "Antiretroviral Therapy" OR "Triple Therapy") AND (Retention OR Concordance OR Adherence OR Compliance) to conduct electronic searches in the following databases: MEDLINE Complete (1916-Dec 2017), Embase (1947-Dec 2017), Global Health (1910-Dec 2017) and CINAHL Complete (1937-Dec 2017). Of the four databases searched, 401 studies were identified with 44 meeting the inclusion criteria. Seven studies were added after searching reference lists of included articles, resulting in 51 articles in total. RESULTS The review demonstrated that stigma, cost of transportation, food deprivation and a woman's disclosure or non-disclosure of her HIV status to a partner, family and the community, could limit or define the extent of her adherence to prescribed antiretroviral drugs during pregnancy. Furthermore, the review indicated that knowledge of HIV status, either before or during pregnancy, was significantly associated with medication adherence. Women who knew their HIV status before pregnancy demonstrated good adherence while women who found out their HIV infection status during pregnancy were linked with non-adherence to ART. CONCLUSION This review revealed several barriers and enablers of adherence among pregnant women taking ART in sub-Saharan Africa. Major barriers included the fear of HIV infection status disclosure to partners and family members, stigma and discrimination. A major enabler of adherence in women taking ART was women's knowledge of their HIV status prior to becoming pregnant. Enhanced effort is needed to facilitate women's knowledge of their HIV status before pregnancy to enable disease acceptance and management, and to support pregnant women and her partner and family in dealing with fear, stigma and discrimination about HIV.
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Affiliation(s)
- Olumuyiwa Omonaiye
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia.
| | - Snezana Kusljic
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Pat Nicholson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood Campus, Melbourne, VIC, 3125, Australia
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Mirkuzie AH. Implementation and outcomes of guideline revisions for the prevention of mother-to-child HIV transmission in Mother Support Programme, Addis Ababa, Ethiopia. PLoS One 2018; 13:e0198438. [PMID: 29927946 PMCID: PMC6013243 DOI: 10.1371/journal.pone.0198438] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 05/20/2018] [Indexed: 11/19/2022] Open
Abstract
About 40% of the new HIV infections in Ethiopia are among children < 15 years of age. The great majority of these infections occur through Mother-to-child HIV transmission (MTCT). For prevention of MTCT, the national guidelines has been revised to incorporate scientific advances in HIV prevention, treatment and care. Since 2005, the country has been implementing a peer mentor programme called Mother Support Group (MSG), which provides psychosocial and adherence support for HIV positive mothers. This study examined implementation of PMTCT guidelines revisions and outcomes of HIV exposed babies in the MSG in Addis Ababa. Retrospective routine data were collected between 2005 and August 2013 from seven randomly selected primary health facilities. Odds ratios and 95% confidence intervals were calculated using logistic regression models. Several guidelines revisions were made between 2001 and 2013 in HIV testing approaches, prophylactic antiretroviral options, infant feeding recommendations and infant HIV testing algorithms. Revisions on the CD4 thresholds were associated with a significant increase in the proportion of women initiating antiretroviral treatment from 0 in 2005 to 62% in 2013. Revisions in infant feeding recommendations led to a 92.3% reported practice of exclusive breastfeeding in 2013 compared to 60.9% in 2005. Two and four percent of the HIV exposed babies were HIV positive by six and 18 months respectively. Not receiving prophylactic ART and receiving mixed feeding were independent predictors for babies having an HIV positive antibody test at 18 months. The rate of HIV status disclosure increased significantly year by year. Over the years, the PMTCT recommendations have moved from having a solo focus on PMTCT to holistic and inclusive approaches emphasizing survival beyond HIV prevention. The data reflect favourable outcomes of HIV exposed babies in terms of averted MTCT though serious gaps in data quality remain. For successful implementation of Option-B plus, the identified gaps in the MSG need to be addressed.
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Affiliation(s)
- Alemnesh H. Mirkuzie
- Ethiopian Public Health Institute, National Data Management Center, Addis Ababa, Ethiopia
- * E-mail:
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Lumbantoruan C, Kermode M, Giyai A, Ang A, Kelaher M. Understanding women's uptake and adherence in Option B+ for prevention of mother-to-child HIV transmission in Papua, Indonesia: A qualitative study. PLoS One 2018; 13:e0198329. [PMID: 29912960 PMCID: PMC6005458 DOI: 10.1371/journal.pone.0198329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
Background Despite a more proactive approach to reducing new HIV infections in infants through lifelong treatment (Option B+ policy) for infected pregnant women, prevention of mother-to-child transmission of HIV (PMTCT) has not been fully effective in Papua, Indonesia. Mother-to-child transmission (MTCT) is the second greatest risk factor for HIV infection in the community, and an elimination target of <1% MTCT has not yet been achieved. The purpose of this study was to improve understanding of the implementation of Option B+ for PMTCT in Papua through investigation of facilitators and barriers to women’s uptake and adherence to antiretroviral therapy (ART) in the program. This information is vital for improving program outcomes and success of program scale up in similar settings in Papua. Methods In-depth interviews were conducted with 20 women and 20 PMTCT health workers at two main referral hospitals for PMTCT in Papua. Development of interview guides was informed by the socio-ecological framework. Qualitative data were managed with NVivo11 software and themes were analysed using template analysis. Factors influencing women’s uptake and adherence in Option B+ for PMTCT were identified through final analysis of key themes. Results Factors that motivated PMTCT uptake and adherence were good quality post-test HIV counselling, belief in the efficacy of antiretroviral (ARV) attained through personal or peer experiences, and a partner who did not prevent women from seeking PMTCT care. Key barriers for PMTCT participation included doubts about ARV efficacy, particularly for asymptomatic women, unsupportive partners who actively prevented women from seeking treatment, and women’s concerns about community stigma and discrimination. Conclusions Results suggest that PMTCT program success is determined by facilitators and barriers from across the spectrum of the socio-ecological model. While roll out of Option B+ as current national policy for pregnant women in Papua has improved detection and enrolment of HIV-positive women, health facilities need to address various existing and potential issues to ensure long-term adherence of women beyond the current PMTCT program, including during pregnancy, childbirth and breastfeeding.
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Affiliation(s)
- Christina Lumbantoruan
- Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Aloisius Giyai
- Provincial Health Office, Papua Provincial Health Office, Jayapura, Papua, Indonesia
| | - Agnes Ang
- Provincial Health Office, Papua Provincial Health Office, Jayapura, Papua, Indonesia
| | - Margaret Kelaher
- Centre for Health Policy, University of Melbourne, Melbourne, Victoria, Australia
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Chagomerana MB, Miller WC, Tang JH, Hoffman IF, Mthiko BC, Phulusa J, John M, Jumbe A, Hosseinipour MC. Optimizing prevention of HIV mother to child transmission: Duration of antiretroviral therapy and viral suppression at delivery among pregnant Malawian women. PLoS One 2018; 13:e0195033. [PMID: 29614083 PMCID: PMC5882113 DOI: 10.1371/journal.pone.0195033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background Effective antiretroviral therapy during pregnancy minimizes the risk of vertical HIV transmission. Some women present late in their pregnancy for first antenatal visit; whether these women achieve viral suppression by delivery and how suppression varies with time on ART is unclear. Methods We conducted a prospective cohort study of HIV-infected pregnant women initiating antiretroviral therapy for the first time at Bwaila Hospital in Lilongwe, Malawi from June 2015 to November 2016. Multivariable Poisson models with robust variance estimators were used to estimate risk ratios (RR) and 95% confidence intervals (CI) of the association between duration of ART and both viral load (VL) ≥1000 copies/ml and VL ≥40 copies/ml at delivery. Results Of the 252 women who had viral load testing at delivery, 40 (16%) and 78 (31%) had VL ≥1000 copies/ml and VL ≥40 copies/ml, respectively. The proportion of women with poor adherence to ART was higher among women who were on ART for ≤12 weeks (9/50 = 18.0%) than among those who were on ART for 13–35 weeks (18/194 = 9.3%). Compared to women who were on ART for ≤12 weeks, women who were on ART for 13–20 weeks (RR = 0.52; 95% CI: 0.36–0.74) or 21–35 weeks (RR = 0.26; 95% CI: 0.14–0.48) had a lower risk of VL ≥40 copies/ml at delivery. Similar comparisons for VL ≥1000 copies/ml at delivery showed decrease in risk although not significant for those on ART 13–20 weeks. Conclusion Longer duration of ART during pregnancy was associated with suppressed viral load at delivery. Early ANC attendance in pregnancy to facilitate prompt ART initiation for HIV-positive women is essential in the effort to eliminate HIV vertical transmission.
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Affiliation(s)
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Jennifer H. Tang
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Irving F. Hoffman
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Bryan C. Mthiko
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jacob Phulusa
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mathias John
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Allan Jumbe
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya. AIDS 2018; 32:233-241. [PMID: 29135576 DOI: 10.1097/qad.0000000000001697] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Assisted partner services (aPS) or provider notification for sexual partners of persons diagnosed HIV positive can increase HIV testing and linkage in Sub-Saharan Africa and is a high yield strategy to identify HIV-positive persons. However, its cost-effectiveness is not well evaluated. METHODS Using effectiveness and cost data from an aPS trial in Kenya, we parameterized an individual-based, dynamic HIV transmission model. We estimated costs for both a program scenario and a task-shifting scenario using community health workers to conduct the intervention. We simulated 200 cohorts of 500 000 individuals and projected the health and economic effects of scaling up aPS in a region of western Kenya (formerly Nyanza Province). FINDINGS Over a 10-year time horizon with universal antiretroviral therapy (ART) initiation, implementing aPS in western Kenya was projected to reach 12.5% of the population and reduce incident HIV infections by 3.7%. In sexual partners receiving aPS, HIV-related deaths were reduced by 13.7%. The incremental cost-effectiveness ratio of aPS was $1094 (US dollars) (90% model variability $823-1619) and $833 (90% model variability $628-1224) per disability-adjusted life year averted under the program and task-shifting scenario, respectively. The incremental cost-effectiveness ratios for both scenarios fall below Kenya's gross domestic product per capita ($1358) and are therefore considered very cost-effective. Results were robust to varying healthcare costs, linkage to care rates, partner concurrency rates, and ART eligibility thresholds (≤350 cells/μl, ≤500 cells/μl, and universal ART). INTERPRETATION APS is cost-effective for reducing HIV-related morbidity and mortality in western Kenya and similar settings. Task shifting can increase program affordability.
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Iacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment-Clinical Points of View and Practical Considerations. Front Pharmacol 2017; 8:831. [PMID: 29218008 PMCID: PMC5703840 DOI: 10.3389/fphar.2017.00831] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/31/2017] [Indexed: 01/19/2023] Open
Abstract
HIV infection is responsible for one the most devastating human pandemics. The advent of antiretroviral therapy has changed the course of the pandemic and saved millions of lives. Complex therapeutic regimens have been introduced since 1996 and have contributed to the transformation of HIV infection into a treatable chronic diseases. New types of potent antiretrovirals and their combinations, including “once daily” treatment, have simplified the regimens and diminished side effects. Nevertheless the adherence to antiretroviral therapy remains unsatisfactory and varies between 27 and 80% across different population in various studies, compared with the required level of 95%. The lack of adherence to antiretroviral therapy is a multi-factorial and dynamic process which raises considerable difficulties for long-term follow-up. Current solutions to this problem are complex. These should be applied by a multidisciplinary team and should take into account key features related to both the individual and social factors as well as to the population to whom it belongs (children, teenagers, elderly, marginalized population like drug users, incarcerated patients, sex workers, etc.). Importantly, adherence should continue to be monitored even in patients known to be compliant. In case of subsequent failure the team should identify the reasons for non-adherence and apply the appropriate methods. Where usual methods have no chance of success, a coordinated package of services also known as “harm reduction” can be offered in order to reduce the risks of transmission. The current article analyses the concept of adherence to antiretroviral therapy, the shortcomings of this medication and the methods that can be applied in practice to increase adherence. Emphasis is placed on the analysis of groups at high risk for HIV infection that currently represent the spearhead with which the HIV pandemic is spreading.
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Affiliation(s)
- Simona A Iacob
- Infectious Diseases Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
| | - Diana G Iacob
- The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
| | - Gheorghita Jugulete
- Infectious Diseases Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,The National Institute of Infectious Diseases "Matei Bals", Bucharest, Romania
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McGrath CJ, Singa B, Langat A, Kinuthia J, Ronen K, Omolo D, Odongo BE, Wafula R, Muange P, Katana A, Ng'anga' L, John-Stewart GC. Non-disclosure to male partners and incomplete PMTCT regimens associated with higher risk of mother-to-child HIV transmission: a national survey in Kenya. AIDS Care 2017; 30:765-773. [PMID: 29130333 DOI: 10.1080/09540121.2017.1400642] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Health worker experience and community support may be higher in high HIV prevalence regions than low prevalence regions, leading to improved prevention of mother-to-child HIV transmission (PMTCT) programs. We evaluated 6-week and 9-month infant HIV transmission risk (TR) in a high prevalence region and nationally. Population-proportionate-to-size sampling was used to select 141 clinics in Kenya, and mobile teams surveyed mother-infant pairs attending 6-week and 9-month immunizations. HIV DNA testing was performed on HIV-exposed infants. Among 2521 mother-infant pairs surveyed nationally, 2423 (94.7%) reported HIV testing in pregnancy or prior diagnosis, of whom 200 (7.4%) were HIV-infected and 188 infants underwent HIV testing. TR was 8.8% (4.0%-18.3%) in 6-week and 8.9% (3.2%-22.2%) in 9-month cohorts including mothers with HIV diagnosed postpartum, of which 53% of infant infections were due to previously undiagnosed mothers. Of 276 HIV-exposed infants in the Nyanza survey, TR was 1.4% (0.4%-5.3%) at 6-week and 5.1% (2.5%-9.9%) at 9-months. Overall TR was lower in Nyanza, high HIV region, than nationally (3.3% vs. 7.2%, P = 0.02). HIV non-disclosure to male partners and incomplete ARVs were associated with TR in both surveys [aOR = 12.8 (3.0-54.3); aOR = 5.6 (1.2-27.4); aOR = 4.5 (1.0-20.0), aOR = 2.5, (0.8-8.4), respectively]. TR was lower in a high HIV prevalence region which had better ARV completion and partner HIV disclosure, possibly due to programmatic efficiencies or community/peer/partner support. Most 9-month infections were among infants of mothers without prior HIV diagnosis. Strategies to detect incident or undiagnosed maternal infections will be important to achieve PMTCT.
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Affiliation(s)
- Christine J McGrath
- a Department of Global Health , University of Washington , Seattle , WA , USA
| | - Benson Singa
- b Centre for Clinical Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Agnes Langat
- c Division of Global HIV and TB , United States Centers for Disease Control and Prevention , Nairobi , Kenya
| | - John Kinuthia
- d Department of Obstetrics and Gynaecology , Kenyatta National Hospital , Nairobi , Kenya
| | - Keshet Ronen
- e Fred Hutchinson Cancer Research Center , Seattle , WA , USA
| | - Danvers Omolo
- b Centre for Clinical Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Benjamin Elly Odongo
- c Division of Global HIV and TB , United States Centers for Disease Control and Prevention , Nairobi , Kenya
| | - Rose Wafula
- f Ministry of Health , National AIDS and STI Control Programme , Nairobi , Kenya
| | - Prisca Muange
- f Ministry of Health , National AIDS and STI Control Programme , Nairobi , Kenya
| | - Abraham Katana
- c Division of Global HIV and TB , United States Centers for Disease Control and Prevention , Nairobi , Kenya
| | - Lucy Ng'anga'
- c Division of Global HIV and TB , United States Centers for Disease Control and Prevention , Nairobi , Kenya
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Gumede-Moyo S, Filteau S, Munthali T, Todd J, Musonda P. Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review. Medicine (Baltimore) 2017; 96:e8055. [PMID: 28984760 PMCID: PMC5737996 DOI: 10.1097/md.0000000000008055] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. METHODS Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). RESULTS Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. CONCLUSION Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
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Affiliation(s)
- Sehlulekile Gumede-Moyo
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Zambia
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tendai Munthali
- School of Public Health, University of Zambia
- Ministry of Health, Lusaka, Zambia
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
Introduction: There are limited data on factors associated with retention in Option B+. We sought to explore the characteristics of women retained in Option B+ in Malawi, with a focus on the role of HIV disclosure, awareness of partner HIV status, and knowledge around the importance of Option B+ for maternal–child health. Methods: We performed a case-control study of HIV-infected women in Malawi initiated on antiretroviral therapy (ART) under Option B+. Cases were enrolled if they met criteria for default from Option B+ (out of ART for >60 days), and controls were enrolled in approximately 3:1 ratio if they were retained in care for at least 12 months. We surveyed socio-demographic characteristics, HIV disclosure and awareness of partner HIV status, self-report about receiving pre-ART education, and knowledge of Option B+. Univariate logistic regression was performed to determine factors associated with retention. Multivariate logistic regression model was used to evaluate the relationship between HIV disclosure, Option B+ knowledge, and retention after adjusting for age, schooling, and travel time to clinic. Results: We enrolled 50 cases and 153 controls. Median age was 30 years (interquartile range (IQR) 25–34), and the majority (82%) initiated ART during pregnancy at a median gestational age of 24 weeks (IQR 16–28). Ninety-one per cent of the cases (39/43) who started ART during pregnancy defaulted by three months postpartum. HIV disclosure to the primary sex partner was more common among women retained in care (100% versus 78%, p < 0.001). Odds of retention were significantly higher among women with: age >25 years (odds ratio (OR) 2.44), completion of primary school (OR 3.06), awareness of partner HIV status (OR 5.20), pre-ART education (OR 6.17), higher number of correct answers to Option B+ knowledge questions (OR 1.82), and support while taking ART (OR 3.65). Pre-ART education and knowledge were significantly correlated (r = 0.43, p < 0.001). In multivariate analysis, awareness of partner HIV status (OR 4.07, 95% confidence interval (CI) 1.51–10.94, p = 0.02) and Option B+ knowledge (OR 1.60, 95% CI 1.15–2.23, p = 0.004) remained associated with retention. Conclusions: Interventions that address partner disclosure and strengthen pre-ART education around the benefits of ART for maternal and child health should be evaluated to improve retention in Malawi’s Option B+ programme.
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Girma M, Wendaferash R, Shibru H, Berhane Y, Hoelscher M, Kroidl A. Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV-infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia. Trop Med Int Health 2017; 22:765-775. [PMID: 28407452 DOI: 10.1111/tmi.12881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the uptake of WHO-recommended PMTCT procedures in Ethiopia's health services. METHODS Prospective observational study of HIV-positive pregnant mothers and their newborns attending PMTCT services at seven health centres in Addis Ababa. Women were recruited during antenatal care and followed up with their newborns at delivery, Day 6 and Week 6 post-partum. Retention to PMCTC procedures, self-reported antiretroviral treatment (ART) adherence and HIV infant outcome were assessed. Turnaround times of HIV early infant diagnosis (EID) procedures were extracted from health registers. RESULTS Of 494 women enrolled, 4.9% did not complete PMTCT procedures due to active denial or loss to follow-up. HIV was first diagnosed in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. ART was initiated in a median of 1.3 weeks (IQR 0-4.3) after HIV diagnosis. Poor self-reported treatment adherence was higher post-partum than during pregnancy (12.5% vs. 7.0%, P = 0.002) and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4 count (RR 1.7, 95% CI 1.0-3.0) and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive, 98.6% received nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7% after a median of 6.7 weeks (IQR 6.4-10.4), but EID results were received for only 46.6% within 3 months of birth. CONCLUSION High retention in PMTCT services, triple maternal ART and high infant nevirapine prophylaxis coverage were associated with low mother-to-child HIV transmission. Declining post-partum ART adherence and challenges of EID linkage require attention.
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Affiliation(s)
- Marshet Girma
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,Center for International Health, University of Munich, Munich, Germany
| | | | | | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Michael Hoelscher
- Center for International Health, University of Munich, Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany.,German Centre for Infection Research, Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany.,German Centre for Infection Research, Munich, Germany
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