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Tusabe J, Nangendo J, Muhoozi M, Muyinda H. Use and non-adherence to antiretroviral therapy among Refugee HIV positive pregnant mothers aged 18-49 years in Kyangwali refugee camp, Western Uganda. AIDS Res Ther 2024; 21:54. [PMID: 39175044 PMCID: PMC11340033 DOI: 10.1186/s12981-024-00645-0] [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: 02/16/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024] Open
Abstract
INTRODUCTION Refugee HIV positive mothers experience significant obstacles in accessing, utilizing and adhering to antiretroviral therapy (ART). Identifying ART non-adherence can help in the development of interventions aimed at improving adherence and subsequently effectiveness of ART among the refugee mothers. We describe the use and the factors associated with non-adherence to ART among Refugee HIV positive pregnant mothers aged 18-49 years in Kyangwali Refugee Camp, Uganda. METHODS We conducted a cross-sectional study among HIV positive pregnant mothers aged 18-49 years in Kyangwali refugee camp between May and June 2023. Using a structured questionnaire, we collected data on use, and factors associated with non-adherence to ART. We used modified Poisson regression analysis to determine factors associated with non-adherence to ART. RESULTS Of the 380 participants enrolled, 192 (50.5%) were married, mean age 32.1 years. Overall, 98.7; 95% Confidence Interval (CI) [97.5-99.8%] were using ART and 27.4; 95% CI [22.9-31.9%] were non-adherent. Non-adherence was associated with: Initiating Prevention of Mother to Child Transmission (PMTCT) care in the third trimester of pregnancy (adjusted Prevalence ration(aPR): 2.06; 95% CI: 1.27-3.35), no need to get permission to seek PMTCT services aPR 1.61; 95% CI [1.07-2.42] and poor attitude of PMTCT providers aPR 1.90; 95% CI [1.20-3.01]. CONCLUSION AND RECOMMENDATIONS Non-adherence to ART was generally high; therefore limiting the effectiveness of the PMTCT program in this setting. Refugee context specific education interventional programs aimed at early initiation into HIV care, strong social and psychological support from families, communities and health care providers are vital to improve adherence in this setting.
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Affiliation(s)
- Joan Tusabe
- College of Health Sciences School of Public Health, Makerere University, Kampala, Uganda.
- Makerere University Center for Health and Population Research, Kampala, Uganda.
| | - Joanita Nangendo
- College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Michael Muhoozi
- Makerere University Center for Health and Population Research, Kampala, Uganda
| | - Herbert Muyinda
- College of Health Sciences, Child Health and Development Center, Makerere University, Kampala, Uganda
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Tusabe J, Nangendo J, Muhoozi M, Muyinda H. Use and non-adherence to antiretroviral therapy among Refugee HIV positive pregnant mothers aged 18-49 years in Kyangwali Refugee Camp, Western Uganda. RESEARCH SQUARE 2024:rs.3.rs-3961640. [PMID: 38464056 PMCID: PMC10925420 DOI: 10.21203/rs.3.rs-3961640/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Introduction Refugee HIV positive mothers experience significant obstacles in accessing, utilizing and adhering to antiretroviral therapy (ART). Identifying ART non-adherence can help enforce interventions aimed at improving adherence and subsequently effectiveness of ART among the refugee mothers. We describe the use and the factors associated with non-adherence to ART among Refugee HIV positive pregnant mothers aged 18-49 years in Kyangwali Refugee Camp, Uganda. Methods We conducted a cross-sectional study among HIV positive pregnant mothers aged 18-49 years in Kyangwali refugee camp between May and June 2023. Using a structured questionnaire, we collected data on use, and factors associated with non-adherence to ART. We used modified Poisson regression analysis to determine factors associated with non-adherence to ART. Results Of the 380 participants enrolled, 192 (50.5%) were married, mean age 32.1 years. Overall, 98.7; 95% CI [97.5-99.8%] were using ART and 27.4; 95% CI [22.9-31.9%] were non-adherent. Non-adherence was associated with; Initiating PMTCT care in the third trimester of pregnancy (aPR: 2.06; 95% CI: 1.27-3.35), no need to get permission to seek PMTCT services aPR 1.61; 95% CI [1.07-2.42] and poor attitude of PMTCT providers aPR 1.90; 95% CI [1.20-3.01]. Conclusion and recommendations Non-adherence to ART was generally high; therefore limiting the effectiveness of the PMTCT program in this setting. Refugee context specific education interventional programs aimed at early initiation into HIV care, strong social and psychological support from families, communities and health care providers are vital to improve adherence this setting.
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Affiliation(s)
- Joan Tusabe
- Makerere University, College of Health Sciences School of Public Health, Kampala, Uganda
| | - Joanita Nangendo
- Makerere University, College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda
| | - Michael Muhoozi
- Makerere University Center for Health and Population Research
| | - Herbert Muyinda
- Makerere University, College of Health Sciences, Child Health and Development Center
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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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Dong Y, Wang L, Burgner DP, Miller JE, Song Y, Ren X, Li Z, Xing Y, Ma J, Sawyer SM, Patton GC. Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017. BMJ 2020; 369:m1043. [PMID: 32241761 PMCID: PMC7114954 DOI: 10.1136/bmj.m1043] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province. DESIGN National surveillance studies, 2008-17. SETTING 31 provinces in mainland China. PARTICIPANTS 4 959 790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups: quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne. MAIN OUTCOME MEASURES Diagnosis of, and deaths from, 44 notifiable infectious diseases. RESULTS From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4 959 790 participants (3 045 905 males, 1 913 885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from infectious diseases decreased steadily from 0.21 per 100 000 population in 2008 to 0.07 per 100 000 in 2017. Quarantinable conditions with high mortality have effectively disappeared. The incidence of notifiable infectious diseases in children and adolescents decreased from 280 per 100 000 in 2008 to 162 per 100 000 in 2015, but rose again to 242 per 100 000 in 2017, largely related to mumps and seasonal influenza. Excluding mumps and influenza, the incidence of vaccine preventable diseases fell from 96 per 100 000 in 2008 to 7 per 100 000 in 2017. The incidence of gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline. Vectorborne diseases all declined, with a particularly noticeable reduction in malaria. Zoonotic infections remained at low incidence, but there were still unpredictable outbreaks, such as pandemic A/H1N1 2009 influenza. Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases. CONCLUSIONS China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Liping Wang
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - David P Burgner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
| | - Jessica E Miller
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Xiang Ren
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Zhongjie Li
- Division of Infectious Disease Control and Prevention, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Haidian District, Beijing 100191, China
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, the University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia
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Kyaw KWY, Satyanarayana S, Phyo KH, Kyaw NTT, Mon AA, Lwin TT, Aung TK, Oo MM, Aung ZZ, Htun T, Kham NSN, Mya T, Kumar AMV, Oo HN. Uptake of antiretroviral therapy in HIV-positive women ever enrolled into 'prevention of mother to child transmission' programme, Mandalay, Myanmar-a cohort study. BMC Pregnancy Childbirth 2018; 18:474. [PMID: 30514239 PMCID: PMC6278152 DOI: 10.1186/s12884-018-2099-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Early initiation and longer duration of anti-retroviral therapy either as prophylaxis (pARV) or lifelong treatment (ART) in HIV-positive pregnant women prior to delivery has a huge impact in reducing mother to child transmission (MTCT) of HIV, maternal morbidity, mortality and increasing retention in care. In this study, we aimed to determine the following in a ‘prevention of mother-to-child transmission’ (PMTCT) programme in Central Women Hospital, Mandalay, Myanmar: i) uptake of ART and factors associated with the uptake ii) duration of ART/ pARV received by HIV-positive pregnant women prior to delivery, iii) factors associated with ART/ pARV initiation after delivery and iv) factors associated with shorter duration of ART/ pARV (≤ 8 weeks prior to delivery). Method This was a retrospective cohort study using routinely collected data from PMTCT programme. We used multivariable Cox proportional Hazard model or log binomial models to assess the association between socio-demographic and clinical factors with a) uptake of ART/pARV, b) initiation of ART/pARV after delivery, c) shorter (≤8 weeks) duration of ART/PARV prior to delivery. Results Of the 670 ART naïve HIV-positive women enrolled to PMTCT programme between March 2011 and December 2016, 588 (88%) were initiated on ART/pARV. In adjusted analysis, only pregnancy stage at enrolment was significantly associated with initiation of ART/pARV. Of 585 who had delivered babies on or before the censor date, 522 (89%) were on ART/pARV. Women who lived outside Mandalay were more likely to be initiated on ART after delivery (i.e., delayed ART initiation in those on ART). Among women who were initiated on ART/pARV before delivery (n = 468), only 59% got ART/pARV for > 8 weeks before delivery. Women whose spouses’ HIV status was not recorded had 40% higher risk of short duration of ART/pARV. Conclusions This study shows high uptake of ART/pARV among those enrolled into the PMTCT programme. However, about one in eight pregnant women did not receive ART before delivery. Among those initiated on ART/pARV before delivery, nearly half of them received ART/pARV for less than 8 weeks prior to delivery. These aspects need to be improved in order to eliminate mother-to-child transmission of HIV.
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Affiliation(s)
- Khine Wut Yee Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar. .,Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
| | - Srinath Satyanarayana
- Center for Operational Research, International Union Against Tuberculosis and Lung disease (The Union), Paris, France
| | - Khaing Hnin Phyo
- HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Nang Thu Thu Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Aye Aye Mon
- HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Than Than Lwin
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thet Ko Aung
- HIV unit, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Myo Minn Oo
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Zaw Zaw Aung
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thurain Htun
- Monitoring, Evaluation, Accountability and Learning Unit, HIV, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Nang Seng Noon Kham
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Theingi Mya
- Department of Obstetrics and Gynecology, Central Women Hospital, Mandalay, Myanmar
| | - Ajay M V Kumar
- Center for Operational Research, International Union Against Tuberculosis and Lung disease (The Union), Paris, France.,Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Delhi, India
| | - Htun Nyunt Oo
- National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
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Lin C, Li L, Ji G. Prevention of mother-to-child transmission of HIV services in China: A conversation between healthcare professionals and migrant women with HIV. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2018; 11:202-209. [DOI: 10.1080/20479700.2017.1330737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA
- Epidemiology Department, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Guoping Ji
- Anhui Provincial Center for Women and Children’s Health, Hefei, China
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Baptiste DJ, Djibril D, Assane S, Ngagne M, Baly O, Ousmane N. [Serological and nutritional outcome of infants born to HIV positive mothers undergoing option B + therapy in Guédiawaye]. Pan Afr Med J 2016; 25:224. [PMID: 28293340 PMCID: PMC5337282 DOI: 10.11604/pamj.2016.25.224.10441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/20/2016] [Indexed: 11/20/2022] Open
Abstract
As part of its Plan to eliminate mother-to-child transmission of HIV, Senegal has adopted, since 2012, WHO's B + option, which consists of systematic triple therapy for HIV-positive pregnant women associated with breastfeeding and antiretroviral (ARV) prophylaxis for their infants. Our study aims to analyze the risks of mother-to-child transmission of HIV and the nutritional outcome of infants undergoing B + option. MATERIAL AND METHODS We conducted a descriptive, retrospective study at the King Baudouin health center in Guédiaway from 1 September 2012 to 30 April 2015. All infants whose mothers were on triple therapy, undergoing protected breastfeeding, ARV prophylaxis and serological test at 14th months were included in the study. The parameters studied were mother's age and serological profile, father's serological status, the sharing of the status within the couple, infant nourishing, infant ARV prophylaxis, nutritional status at 6 and 12 months and serological status of the infant at 14 months. Out of the 126 infants undergoing PMTCT program, 42 or 33.33% of infants following the B + guidelines were included in the study. The age of mothers ranged from 15 to 42 years, with an average age of 31 years. The majority of mothers (88.1%) carried type 1 virus and 11.9% carried type 2 virus; 20 couples (47.62%) were sero-concordant, 14 were serodifferent, while the serological status was unknown or not investigated in 8 fathers (19.05%). A significant difference between fathers' serological profile and the sharing status (p <0.05) was found. The majority of infants (88.1%) were born at term via vaginal delivery (95.2%), with an average birth weight of 2880 grams. In relation to prophylaxis, the majority of infants received prophylactic monotherapy, 27 (64.28%) received NVP, 4 (9.52%) received AZT, while 11 (26.19%) received triple combination of AZT + 3TC + NVP. The AME was effective in 80.9% of infants and weaning began at 12 months in 80.9% of infants. In relation to nutritional status, at 6 months 12% and 7.1% of infants had MAM and MAS respectively. At 12 months, 19.1% of infants had MAM. Retroviral serology was negative in all the 42 infants at 14 months. B + option is an effective strategy to reduce the MTCT rate. However, early malnutrition in children requires nutritional support for breastfeeding mothers as well as a good psychosocial support.
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Affiliation(s)
| | - Diallo Djibril
- Clinique Gynécologique et Obstétricale, Hôpital Aristide Le Dantec Dakar. Avenue Pasteur, BP: 3001 Dakar, Sénégal
| | | | - Mbaye Ngagne
- ONG Synergie pour l'enfance, Cité Lobatt Fall Pikine, BP: 20330 Thiaroye
| | - Ouattara Baly
- ONG Synergie pour l'enfance, Cité Lobatt Fall Pikine, BP: 20330 Thiaroye
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