Abstract
BackgroundContext-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa.MethodsThis was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence.ResultsA high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART.ConclusionsNon-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.
Highlights
Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with Human immunodeficiency virus (HIV)
Using a mixed methods design, this study examined the level of adherence to ART during pregnancy, and explored correlates of non-adherence and reasons for non-adherence in the Eastern Cape
The majority of the participants booked during the second trimester (73.2%), knew their HIV positive status before booking (80.9%) and were already on ART (58.4%)
Summary
Study design and settings We conducted a sub-analysis of the electronic database of a larger study (East London Prospective Cohort Study) [27] This multi-centre study was conducted in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province, South Africa. This study adopted a mixed-methods descriptive design involving the use of a questionnaire and semi-structured interviews for eliciting information from research participants. A total of 177 purposively selected HIV infected parturient women, who self-reported non-adherence to ARV, were interviewed. Adherence measure by drug-refill has been demonstrated to be a useful early warning indicator of virological and immunological failure among HIV-infected individuals [29]. Correlates of ARV adherence Participants reported their age, level of education, marital status, employment status, and place of residence Participants indicated their lifestyle behaviours; cigarette smoking and alcohol consumption status before and during the index pregnancy. The researcher ensured the rights of participants during and after the study
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