Impact of attitudes and beliefs on antiretroviral treatment adherence intention among HIV-positive pregnant and breastfeeding women in Zambia

Jerry John Nutor,Kelechi Elizabeth Oladimeji,Florence Momplaisir,Rose Ann Dimaria-Ghalili,Shannon P Marquez,Jaime C Slaughter-Acey,Loretta S Jemmott

doi:10.1186/s12889-020-09505-8

Abstract

ObjectiveThe aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia.MethodsWe recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART.ResultsIntention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps < .05). In addition, strong intention to adhere to ART differed by urban (69%) and rural (31%) place of residence (P ≤ .01). In adjusted models, women in the weak adherence intention group were more likely to be older, have less knowledge about HIV transmission, and have a more negative attitude toward ART (PR 0.74; 95% CI 0.67–0.82). Behavioral belief about ART, however, was significant in unadjusted model (PR 0.85; 95% CI 0.76–0.94) but not significant after adjusting for covariates such as age, knowledge of transmission, and district locality.ConclusionCompared to behavioral beliefs, attitudes about ART were more influential for intention to adhere. This knowledge will help inform effective and appropriate ART counseling for pregnant and breastfeeding women at different points along their ART time course.

Highlights

There are approximately 85,000 Human Immunodeficiency Virus (HIV)-positive children living in Zambia [1]
Option B+ was standard of care in Zambia until 2015, when the World Health Organization (WHO) expanded to a “90-90-90: Treatment for All” policy with the goal of diagnosing 90% of all people living with HIV, place 90% of diagnosed people on antiretroviral therapy (ART), and achieving 90% viral suppression in treated people by 2020
Our findings indicate that women with more negative attitudes and behavioral beliefs about ART are less likely to have a strong intention to adhere to ART

Summary

Introduction

There are approximately 85,000 HIV-positive children living in Zambia [1]. The source of infection is primarily through vertical transmission during pregnancy [2], childbirth [2] or breastfeeding from an HIV-positive mother [3, 4]. Option B+ was standard of care in Zambia until 2015, when the WHO expanded to a “90-90-90: Treatment for All” policy with the goal of diagnosing 90% of all people living with HIV, place 90% of diagnosed people on ART, and achieving 90% viral suppression in treated people by 2020. After the introduction of Option B+, ARV drug use in pregnant and breastfeeding women in Zambia increased from 65% in 2013 to 80% in 2017 [11,12,13], yet adherence to treatment has been problematic. Poor adherence to ART is related to factors that can be categorized as: patient-related (e.g., forgetting to take the medication or being too busy) [14], interpersonal (i.e. stigma and discrimination) [15], financial difficulty [14], health system (i.e. inaccessibility of services and relationships with service providers) [9, 16] and drug-related (i.e. side effects) [7, 13]

Methods

Results

Discussion

Conclusion