Abstract
Introductionregular 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.Methodsa 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.Resultsa 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.Conclusionadherence 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).
Highlights
According to the World Health Organisation (WHO) by the end of 2016, about 19.5 million people were receiving Antiretroviral Therapy (ART) worldwide [1]
Poor adherence is associated with poor virological outcomes and increased oxidative stress which can result in preeclampsia [14,15,16,17,18,19], increased mortality [20,21,22], reduced durability and effectiveness of regimens [23,24] developing drug resistance [2527]
There was no evidence of a difference in adherence when compared by the level of education (P=0.659), occupation (P=0.327) and marital status (P=0.353) though we could not rule out chance finding
Summary
According to the World Health Organisation (WHO) by the end of 2016, about 19.5 million people were receiving ART worldwide [1]. The ministry of health (MoH) adopted 2014, Joint United Nations Programme on HIV/ AIDS (UNAIDS) ambitious global targets, including "90-90-90" by the year 2020 which means that 90% of all people with diagnosed HIV infection will receive sustained ART [7] This approach will no doubt bring about a reduction in new infections as most patients will have a suppressed viral load. Drug resistance is more complicated to deal with, and costlier in that alternative drugs are more expensive, have more side effects, and are not as widely available as 1st line drugs [28,29,30] It is not clear in current medical literature the adherence levels to option B+ and associated factors related to pregnant women attending ANC at 1st level Chilenje Hospital in Lusaka, Zambia. This study was set out to establish adherence levels and associated factors to better inform policy guidelines on simple, cost-effective interventions that would improve ART and maternal outcomes at 1st level Chilenje Hospital and other hospitals in Zambia
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