Abstract
BackgroundThe Prevention of Mother to Child Transmission of HIV (PMTCT) programme was introduced at Bindura Hospital in 2003. Seven additional satellite PMTCT clinics were set up in the district to increase service coverage but uptake of PMTCT interventions remained unsatisfactory. In this study we determined the prevalence of and factors associated with non-adherence to the single dose nevirapine (SD-NVP) regimen for PMTCT in Bindura town.MethodsAn analytic cross-sectional study was conducted in four health institutions in Bindura town. Participants were mother-baby pairs on the PMTCT programme attending routine six weeks post natal visits in the participating health institutions from March to July 2008. We interviewed 212 mothers using a structured questionnaire.ResultsThe non-adherence rate to the maternal nevirapine dose was 30.7%, while non-adherence to the newborn nevirapine dose was 26.9%. The combined mother-baby pair nevirapine non-adherence was 42.9%. Non-adherence to the maternal dose of nevirapine was associated with lack of maternal secondary education (POR = 2.38; 95%CI: 1.05-3.39) and multi-parity (POR = 2.66; 95%CI: 1.05-6.72), while previous maternal exposure to the PMTCT programme (POR = 0.22; 95%CI: 0.08-0.57) and giving the mother a NVP tablet to take home during antenatal care (POR = 0.03; 95%CI: 0.01-0.09) were associated with improved maternal adherence to nevirapine. Non-adherence to the infant dose of nevirapine was associated with maternal non-disclosure of HIV results to sexual partner (POR = 2.75; 95%CI: 1.04-7.32) and home deliveries (POR = 48.76; 95%CI: 17.51-135.82).ConclusionsNon-adherence to nevirapine prophylaxis for PMTCT was high in Bindura. Ensuring institutional deliveries, encouraging self-disclosure of HIV results by the mothers to their partners and giving HIV positive mothers nevirapine doses to take home early in pregnancy all play significant roles in improving adherence to PMTCT prophylaxis.
Highlights
The Prevention of Mother to Child Transmission of Human Immunodeficiency Virus (HIV) (PMTCT) programme was introduced at Bindura Hospital in 2003
The infant dose of NVP is important for the regimen to be effective and the prophylaxis cannot be considered complete without administration of the infant NVP dose
Giving the HIV positive mother a nevirapine dose to take home during antenatal care, giving birth in health institutions and self disclosure of HIV results by the mother to the partner were associated with reduced nevi
Summary
The Prevention of Mother to Child Transmission of HIV (PMTCT) programme was introduced at Bindura Hospital in 2003. Mother-to-child transmission of HIV (MTCT) during pregnancy, delivery, or breastfeeding accounts for more than 90% of the HIV infections in children below 15 years of age [3,4]. Studies have shown that short-course, easy-touse, and affordable antiretroviral regimens can significantly reduce MTCT of HIV. One such regimen is the single-dose nevirapine (SD-NVP) regimen, in which the mother ingests a dose of nevirapine (NVP) at the onset of labor (at least 2 hrs before delivery) and another dose is given to the baby within 72 hrs of birth [4,6,7,8]
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