Factors that determine the level of non-adherence to HAART among HIV-positive pregnant women in Kaduna State

Abstract

Despite a decreased trend in the global HIV burden, up to 46% of fresh infections were reported in women and girls in 2022, with sub-Saharan Africa accounting for 70% of cases. One of the reasons HIV remains a major public health threat in Nigeria, the most populous country in Africa, is pregnant women's non-adherence to ART, which can lead to drug resistance resulting in the transmission of the virus to the unborn child. This study was aimed at determining the levels of non-adherence and identifying factors determining non-adherence to ART among HIV-positive pregnant women in Kaduna state. It was a cross-sectional study using a three-stage sampling technique. It involved 318 HIV-positive pregnant women attending ANC in nine selected hospitals. Electronic questionnaires were administered over 10 weeks. Non-adherence was assessed using four validated techniques. Pill count calculation was used as an indicator of non-adherence for further analysis on account of its documented correlation with better adherence. Bivariate and multivariate analyses were done with Microsoft Excel and Epi Info software. Levels of non-adherence ranged from 5.7% (3-day recall) to 28.6% (7-day recall) to 6.6% (Visual Analogue Scale) to 13.8% (Pill Count). Of all the factors affecting non-adherence (pill count), having a negative attitude toward ART was significantly associated with non-adherence. The level of non-adherence, a function of the assessment method, is lower than in most similar studies. We propose that qualified staff should enhance effective ongoing triage-based interventions using a graded baseline assessment to ensure that all HIV-pregnant women on HAART attain optimal adherence.