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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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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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Vertical HIV transmission within 18 months post partum among women on lifelong antiretroviral therapy for HIV in Dar es Salaam, Tanzania: a prospective cohort study. Lancet HIV 2023; 10:e33-e41. [PMID: 36495896 DOI: 10.1016/s2352-3018(22)00289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The UNAIDS estimate of vertical HIV transmission in Tanzania is high (11%), despite 84% uptake of antiretroviral therapy (ART) among pregnant women with HIV. We aimed to evaluate vertical transmission and its determinants by 18 months post partum among women on lifelong ART in routine health-care settings in Tanzania. METHODS We conducted a prospective cohort study in 226 health facitilies across Dar-es-Salaam, Tanzania. Eligible participants were pregnant women of any age with HIV, and later their infants, who enrolled in routine health-care services for the prevention of vertical transmission. We prospectively followed up mother-infant pairs at routine monthly visits until 18 months post partum and extracted data from the care and treatment clinic (CTC2) database, a national electronic database that stores patient-level HIV care and treatment clinic data. The primary outcome was time from birth to HIV diagnosis, defined as a positive infant HIV DNA PCR or antibody test from age 18 months. We used the Kaplan-Meier method to estimate cumulative risk of vertical transmission by 18 months post partum and Cox proportional hazards regression with shared frailties to account for potential clustering in health facilities to evaluate predictors of transmission. FINDINGS Between Jan 1, 2015, and Dec 31, 2017, 22 930 pregnant women with HIV (median age 30 years, IQR 25-34) enrolled on a care programme. After excluding 9140 (39·9%) women and 539 (2·4%) infants with missing outcome data, 13 251 (59·0%) mother-infant pairs were analysed, of whom 6072 (45·8%) women were already on ART before pregnancy. By 18 months post partum, 159 (1·2%) of 13 251 infants were diagnosed with HIV, equivalent to a risk of vertical transmission of 1·4% (95% CI 1·2-1·6). In the complete case analysis, the rates of vertical transmission were higher among women who enrolled in the third trimester of pregnancy than among those who enrolled in the first trimester (adjusted hazard ratio 3·01, 95% CI 1·59-5·70; p=0·0003), among women with advanced HIV disease than among those with early-stage disease (1·89, 1·22-2·93; p=0·0046), and among women who were on a second-line ART regimen than among those on a first-line regimen (3·58, 1·08-11·82; p=0·037). By contrast, the rate of vertical transmission was lower among women who were already on ART at enrolment than among those starting ART at enrolment (0·39, 0·25-0·60; p<0·0001) as well as among women in high-volume clinics than among those in low-volume clinics (0·46 (0·24-0·90; p<0·0097). INTERPRETATION Provision of ART for life (WHO's option B+ recommendation) has reduced the risk of vertical transmission to less than 2% among pregnant women with HIV in routine care settings in urban Tanzania. There is still a need to improve timely HIV diagnosis and ART uptake, and to optimise follow-up for the prevention of vertical transmission and the uptake of infant HIV testing. FUNDING Swedish International Development Cooperation Agency.
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Mutambanengwe-Jacob MT, Maponga CC, Amico KR, Ngara B, Yende-Zuma N, Chawana TD, Nematadzira T, Gumbo JF, Goverayi T, Matibe P, Malunda BV, Aizire J, Taha TE, Fowler MG, Stranix-Chibanda L. Impact of Motivational Enhanced Adherence Counseling and Point-of-Care Viral Load Monitoring on Viral Load Outcome in Women on Life-Long ART: A Randomized Pilot Study. AIDS Res Treat 2022; 2022:4887202. [PMID: 36105074 PMCID: PMC9467808 DOI: 10.1155/2022/4887202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/13/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
We piloted the combined effectiveness of point-of-care viral load monitoring plus motivational enhanced adherence counseling (intervention) compared with routine care (control) in women identified at risk of virologic failure in the PROMOTE study in Zimbabwe. In an unblinded randomized study, consenting women with last viral load ≥200 copies/ml and/or pill count outside 90-110% range were randomized 1 : 1 to receive the intervention or continue routine care, comprising laboratory-based VL monitoring and standard EAC, from trained nurses and counsellors. Viral load was measured 0, 3, 6, and 12 months after enrolment. We compared viral suppression <200 copies/ml at 6 and 12 months between the arms through Fisher's exact test and sought associated factors by logistic regression with a 95% confidence interval (CI). Between December 2018 and July 2019, 50 women were enrolled (25 intervention and 25 controls) and followed until November 2020. At entry, 60% of the women were virally suppressed, 52% intervention vs. 68% control arm. Viral suppression was balanced between the two arms (p value = 0.248). At month 6 post study entry (primary endpont), 64% of the women retained in care were virally suppressed, 54% intervention vs. 76% control arm (p value = 0.124). At month12 post study entry (secondary endpoint), 69% of the women retained in care were virally suppressed, 67% intervention vs. 71% control arm women (p value = 0.739). More intervention women completed all scheduled sessions by month 6. Control group women were more likely to be virally suppressed at both timepoints. Only 25% had treatment switch by 12 months. Despite intense adherence support and viral load monitoring, sustained viral suppression remained elusive in women identified at risk of viral failure. These findings highlight the continued need for effective adherence intervention for women with unsuppressed HIV viral loads, efficient treatment switch strategies, as well as drug level monitoring.
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Affiliation(s)
- Mercy T. Mutambanengwe-Jacob
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Charles C. Maponga
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Bernard Ngara
- Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa
| | - Tariro D. Chawana
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Justice F. Gumbo
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Tendayi Goverayi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Petronella Matibe
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | | | - Jim Aizire
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Taha E. Taha
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary G. Fowler
- Department of Pathology, The Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lynda Stranix-Chibanda
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Child and Adolescent Health Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Astawesegn FH, Stulz V, Conroy E, Mannan H. Trends and effects of antiretroviral therapy coverage during pregnancy on mother-to-child transmission of HIV in Sub-Saharan Africa. Evidence from panel data analysis. BMC Infect Dis 2022; 22:134. [PMID: 35135474 PMCID: PMC8822759 DOI: 10.1186/s12879-022-07119-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Antiretroviral therapy for pregnant women infected with HIV has evolved significantly over time, from single dosage antiretroviral and zidovudine alone to lifelong combination of antiretroviral therapy, but the effect of the intervention on population-level child HIV infection has not been well studied in sub-Saharan Africa. Therefore, this study aimed to establish the trend and effect of ART coverage during pregnancy on mother-to-child HIV transmission in sub-Saharan Africa from 2010 to 2019. Methods Country-level longitudinal ecological study design was used. Forty-one sub-Saharan Africa countries were included using publicly available data from the United Nations Programme on HIV/AIDS, World Health Organization, and World Bank. We created a panel dataset of 410 observations for this study from the years 2010–2019. Linear fixed effects dummy variable regression models were conducted to measure the effect of ART coverage during pregnancy on MTCT rate. Regression coefficients with their 95% confidence intervals (CIs) were estimated for each variable from the fixed effects model. Results ART coverage during pregnancy increased from 32.98 to 69.46% between 2010 and 2019. Over the same period, the rate of HIV transmission from mother to child reduced from 27.18 to 16.90% in sub-Saharan Africa. A subgroup analysis found that in southern Africa and upper-middle-income groups, higher ART coverage, and lower MTCT rates were recorded. The fixed-effects model result showed that ART coverage during pregnancy (β = − 0.18, 95% CI − 0.19–− 0.16) (p < 0.001) and log-transformed HIV incidence-to-prevalence ratio (β = 5.41, 95% CI 2.18–8.65) (p < 0.001) were significantly associated with mother-to-child HIV transmission rate. Conclusions ART coverage for HIV positive pregnant women and HIV incidence-to-prevalence ratio were significantly associated with MTCT rate in sub-Saharan Africa. Based on these findings we suggest countries scale up ART coverage by implementing varieties of proven strategies and control the HIV epidemic to achieve the global target of eliminating MTCT of HIV in the region.
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Affiliation(s)
- Feleke Hailemichael Astawesegn
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown campus, Penrith, NSW, 2751, Australia. .,School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Virginia Stulz
- School of Nursing and Midwifery Centre for Nursing and Midwifery Research, Western Sydney University, Nepean Hospital 1st Level Court Building, Derby Street, Kingswood, NSW, 2340, Australia
| | - Elizabeth Conroy
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown campus, Penrith, NSW, 2751, Australia
| | - Haider Mannan
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown campus, Penrith, NSW, 2751, Australia
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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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Masiano S, Machine E, Mphande M, Markham C, Tembo T, Chitani M, Mkandawire A, Mazenga A, Ahmed S, Kim M. Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041737. [PMID: 33579047 PMCID: PMC7916796 DOI: 10.3390/ijerph18041737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.
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Affiliation(s)
- Steven Masiano
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Correspondence: (S.M.); (M.K.)
| | - Edwin Machine
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mtisunge Mphande
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Christine Markham
- Center for Health Promotion and Preventive Research, Department of Health Promotion and Behavioral Sciences, The University of Texas, Houston, TX 77030, USA;
| | - Tapiwa Tembo
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Mike Chitani
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Angella Mkandawire
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
| | - Maria Kim
- Baylor College of Medicine Children’s Foundation Malawi, PBAG B397, Lilongwe, Malawi; (E.M.); (M.M.) (T.T.); (M.C.); (A.M.); (A.M.); (S.A.)
- Section of Retrovirology and Global Health, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (S.M.); (M.K.)
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Triulzi I, Keiser O, Somerville C, Salimu S, Ciccacci F, Palla I, Sagno JB, Gondwe J, Marazzi C, Orlando S, Palombi L, Turchetti G. Social determinants of male partner attendance in women's prevention-of mother-to-child transmission program in Malawi. BMC Public Health 2020; 20:1821. [PMID: 33256655 PMCID: PMC7708238 DOI: 10.1186/s12889-020-09800-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/29/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Male partners are rarely present during PMTCT (Prevention-Mother-To-Child-Transmission) services in Sub-Saharan Africa (SSA). Male involvement is increasingly recognised as an important element of women's access to care. This study aims to identify the socio-demographic characteristics, HIV-Knowledge, Attitude and Practice (KAP) among women accompanied and not accompanied by their male partners. METHODS We included pregnant women enrolled in PMTCT programme between August 2018 and November 2019 in the Southern Region of Malawi. Eligible women were aged 18 years or older, living with a male partner, enrolled for the first time in one of the four selected facilities. We provided a KAP survey to women and their partners attending the facilities. Our primary objective was to assess and analyse the proportion of women who were accompanied by their partner at least once. We applied descriptive statistics and logistic regressions to study the association between being accompanied and explanatory variables. RESULTS We enrolled 128 HIV-positive women: 82 (64.1%) were accompanied by their male partners and 46 (35.9%) were alone. In the multivariable model, women's unemployment and owning a means of transport are negatively associated with male attendance (respectively adjusted OR 0.32 [95% CI, 0.11-0.82] and 0.23 [95% CI, 0.07-0.77]), whereas, in the univariable model, high women's level of knowledge of HIV is positively associated with male attendance (OR 2.17 [95% CI, 1.03-4.58]). Level of attitude and practice toward HIV were not significantly associated to our study variable. CONCLUSIONS Our study shows a high male attendance in Malawi compared to other studies performed in SSA. This study highlights that women's level of knowledge on HIV and their economic condition (employment and owning a means of transport) affects male attendance. Moreover, the study points out that gender power relationships and stringent gender norms play a crucial role thus they should be considered to enhance male involvement.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri Libertà, 56127, Pisa, Italy.
- Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Claire Somerville
- Gender Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri Libertà, 56127, Pisa, Italy
| | | | - Jane Gondwe
- DREAM Programme, Community of Sant'Egidio, Blantyre, Malawi
| | | | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | - Giuseppe Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri Libertà, 56127, Pisa, Italy
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10
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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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11
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Ngowi KM, Maro E, Aarnoutse RE, Mmbaga BT, Sprangers MAG, Reiss P, Nieuwkerk PT, Boer IMSD. Feasibility of SMS to remind pregnant and breastfeeding women living with HIV to take antiretroviral treatment in Kilimanjaro region, Tanzania: a pilot study. East Afr Health Res J 2020; 4:140-148. [PMID: 34308231 PMCID: PMC8279205 DOI: 10.24248/eahrj.v4i2.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Pregnant and breastfeeding Women Living with HIV (WLHIV) often have difficulties in reaching adequate levels of adherence (>95%) to Antiretroviral treatment. “Forgetting” is the most commonly mentioned reason. Sending reminders via SMS is expected to improve adherence. We conducted a pilot study to investigate acceptability, user experience and technical feasibility of sending reminder-SMS to WLHIV. Methods: This was a 6-months observational pilot-study among WLHIV attending antenatal and postnatal care at Kilimanjaro Christian Medical Centre in Moshi, Tanzania. Women received a reminder-SMS 30 minutes before usual time of intake. One hour later, they received an SMS asking whether they took medication to which they could reply with ‘Yes’ or ‘No’. Messages were sent 3 times a week on randomly chosen days to prevent reliance on daily messages. We calculated the percentage of number of SMS delivered, failed to be delivered, and replied to. We analysed feedback from exit-interviews about experience with the SMS-reminders. Results: 25 women were enrolled (age 18-45), 2 were lost to follow up. 5,054 messages were sent of which 53 failed to be delivered (1%). 1,880 SMS were sent with a question if medication was taken; 1,012 (54%) messages were replied to, of which 1,003 (99%) were replied with ‘YES’ and closely to ‘YES’, and a total of 9 (1%) with ‘NO’ and ‘closely to NO’. 868 messages (46%) were not responded to due to either dropout, change of phone number, loss of phone or network failure. Results from 18 interviews showed that 16 (89%) women were satisfied with SMS reminders. 2 (11%) were concerned about unwanted disclosure because of the content ‘don't forget to take medication’ and one reported other privacy issues (6%). 3 (17%) women experienced stigma. Conclusion: 99%of SMS being delivered indicates that SMS reminders in this resource-limited setting are technically feasible. However, concerns regarding privacy were noted, specifically the risk of unwanted disclosure and the experience of stigma. Participants indicated that being made aware of their adherence, motivated them to adhere better. However, personalised and more neutral content of the SMS might be a way to improving the intervention.
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Affiliation(s)
- Kennedy M Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania, United Republic of.,Amsterdam UMC, Location AMC, University of Amsterdam, Department of MedicalPsychology, Amsterdam, The Netherlands
| | - Eusebious Maro
- Kilimanjaro Christian Medical Center, Moshi, Tanzania, United Republic of.,Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
| | - Rob E Aarnoutse
- Radboudumc, Radboud Institute for Health Sciences & Department of Pharmacy, Nijmegen, The Netherlands
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania, United Republic of.,Kilimanjaro Christian Medical Center, Moshi, Tanzania, United Republic of.,Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
| | - Mirjam A G Sprangers
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of MedicalPsychology, Amsterdam, The Netherlands
| | - Peter Reiss
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of Global Health, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.,HIV Monitoring Foundation, Amsterdam, the Netherlands
| | - Pythia T Nieuwkerk
- Amsterdam UMC, Location AMC, University of Amsterdam, Department of MedicalPsychology, Amsterdam, The Netherlands
| | - I Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania, United Republic of.,Radboudumc, Department of Internal Medicine: infectious diseases, Nijmegen, the Netherlands
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12
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Abstract
PURPOSE OF REVIEW Biological and societal influences are different for men and women leading to different HIV outcomes and related infectious and non-infectious complications. This review evaluates sex differences in the epidemiology and immunological response to HIV and looks at major complications and coinfections, as well as care delivery systems focusing on low- and middle-income countries (LMICs) where most people with HIV live. RECENT FINDINGS More women than men access testing and treatment services in LMIC; women are more likely to be virologically suppressed in that environment. There is a growing recognition that the enhanced immunological response to several pathogens including HIV may result in improved outcomes for infectious comorbidities but may result in a greater burden of non-communicable diseases. Men and women have different requirements for HIV care. Attention to these differences may improve outcomes for all.
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13
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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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14
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Mudavanhu M, West NS, Schwartz SR, Mutunga L, Keyser V, Bassett J, Van Rie A, Hanrahan CF. Perceptions of Community and Clinic-Based Adherence Clubs for Patients Stable on Antiretroviral Treatment: A Mixed Methods Study. AIDS Behav 2020; 24:1197-1206. [PMID: 31560093 PMCID: PMC9933863 DOI: 10.1007/s10461-019-02681-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Adherence clubs for patients stable on antiretroviral treatment (ART) offer decongestion of clinics and task-shifting, improved adherence and retention in care. Findings on patient acceptability by club location (in the clinic vs. the community) are limited. This was a mixed-methods study set within a randomized controlled trial of community versus clinic-based adherence clubs for retention in care at Witkoppen Health and Welfare Centre in Johannesburg, South Africa. Participants were surveyed on preferences for adherence club-based care (e.g. location, convenience). We conducted in-depth interviews (IDIs) with 36 participants, and surveyed 568 participants: 49% in community-based clubs and 51% in clinic-based clubs. Participants in both arms favorably rated adherence clubs. Almost all (95%) in clinic-based clubs would recommend them to a friend, while fewer (88% in community-based club participants would do so (p = 0.004). Participants found clubs promoted social support, and were convenient and time-saving, though concerns around stigma and access to other health care were noted within community-based clubs. Adherence clubs are a highly acceptable form of differentiated care for stable ART patients. These data indicate that clinic-based clubs may be preferred above community-based clubs, potentially for reasons of stigma and access to additional health care services.
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Affiliation(s)
- Mutsa Mudavanhu
- Witkoppen Health and Welfare Centre, Fourways, Johannesburg, South Africa
| | - Nora S. West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sheree R. Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Lillian Mutunga
- Witkoppen Health and Welfare Centre, Fourways, Johannesburg, South Africa
| | - Valerie Keyser
- Witkoppen Health and Welfare Centre, Fourways, Johannesburg, South Africa
| | - Jean Bassett
- Witkoppen Health and Welfare Centre, Fourways, Johannesburg, South Africa
| | - Annelies Van Rie
- Epidemiology for Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Colleen F. Hanrahan
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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15
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Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa. PLoS One 2020; 15:e0229592. [PMID: 32106255 PMCID: PMC7046212 DOI: 10.1371/journal.pone.0229592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART), especially during the postpartum period, remains a major challenge in the efforts towards eliminating mother-to-child transmission of HIV. This study examined the levels and determinants of postpartum adherence to ART among mothers with HIV in the Eastern Cape, South Africa. METHODS In this cross-sectional analytical study, we interviewed 495 postpartum women with HIV between January and May 2018. We measured postpartum adherence using six questions probing participants' adherence behaviours since child birth. We categorised the adherence behaviours into complete adherence (mothers who reported no missed episode(s) of ART since child birth) and suboptimal adherence (mothers with any missed episode(s) of ART). Adjusted and unadjusted logistic regression models were used to examine the determinants of postpartum adherence to ART. RESULTS Overall, 63.9% reported complete adherence during the postpartum period but the rates varied by socio-demographic and behavioural characteristics. The adjusted logistic regression analysis showed that younger mothers were 70% less likely to report complete adherence to ART compared to mothers aged 40 and above. Likewise, mothers who currently use alcohol were 53% less likely to report complete postpartum adherence to ART compared to those who did not use alcohol. However, mothers who knew their partner's status were twice more likely to report complete postpartum adherence compared to those who did not. There was no statistically significant relationship between ART adherence and breastfeeding durations. CONCLUSION Postpartum adherence to ART is suboptimal in the study setting, and younger mothers and those who use alcohol have a lower odds of complete adherence. Knowing a partner's status improves adherence, but infant feeding practices did not influence postpartum adherence behaviours. It is critical to design and strengthen interventions which target young mothers and alcohol users. Also, HIV sero-status disclosure should be encouraged among mothers to facilitate partner support.
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16
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Mukosha M, Chiyesu G, Vwalika B. Adherence to antiretroviral therapy among HIV infected pregnant women in public health sectors: a pilot of Chilenje level one Hospital Lusaka, Zambia. Pan Afr Med J 2020; 35:49. [PMID: 32537054 PMCID: PMC7250199 DOI: 10.11604/pamj.2020.35.49.20078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/24/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction regular use of Antiretroviral Therapy (ART) in pregnancy and breastfeeding reduces the odds of Mother-to-Child HIV Transmission (MTCT). However, adherence to ART is critical for MTCT to be successful. The present study investigated factors that influence adherence to ART among HIV infected pregnant women in Zambia. Methods a cross-sectional study design was conducted involving 71 HIV infected pregnant women who were advised to join the Prevention of Mother-to-Child HIV Transmission (PMTCT) program during their routine Antenatal clinic (ANC) visit and were on ART for more than six months. We used the Medication Possession Ratio (MPR) to quantify adherence levels. We used logistic regression to establish factors that influence adherence to ART. Results a total of 71 HIV infected pregnant women with a median age of 27years (IQR, 25-30) were enrolled in the study. There was evidence of a difference in adherence levels between pregnant women above 30 years and ones between 15 years and 30 years (P<0.001). Median adherence levels in this group were found to be at 96%(IQR 89-97). The main predictor of adherence in this population was marital status (being on separation) and age. The women who were on separation were 0.14 times less likely to adhere to option B+ compared to married women. Conclusion adherence to option B+ among pregnant women is low. Adherence was significantly influenced by marital status (being on separation) and age. Efforts to improve adherence should be directed towards women on separation and young adults (< 30 years of age).
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Affiliation(s)
- Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka, Zambia.,Mosi-o-Tunya University of Science and Technology, Lusaka, Zambia
| | - Grace Chiyesu
- Faculty of Pharmacy Nutrition and Dietetics, Apex Medical University, Lusaka, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
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