Abstract
BackgroundDespite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers’ adherence to option B plus is still a challenge. Though few primary studies are available on the magnitude of adherence to option B plus and factors associated in Eastern African countries, they do not provide strong evidence in helping policymakers to address suboptimal adherence to option B plus. Therefore, this systematic review and meta-analysis was intended to estimate the pooled magnitude of adherence to option B plus program and associated factors among women in Eastern African countries.MethodsPubMed, Medline, HINARI, Cochrane library, the Web of Science, and Google Scholar were searched for studies reported on the magnitude of adherence to option B plus among women in Eastern African countries. The search terms used were “option B plus”, “magnitude”, “prevalence”, “PMTCT”, “ART adherence”, “associated factors”, “all lists of Eastern African countries” and their combination by Boolean operators. The effect sizes of the meta-analysis were the magnitude of adherence to option B plus and the odds ratio of the associated factors. STATA/SE V14 was used for statistical analysis, and publication bias was assessed using funnel plots and Egger’s test.ResultsFourteen studies having total participants of 4883 were included in the systematic review and meta-analysis. Using the random effect model, the pooled prevalence of adherence to option B plus was 71.88% (95% CI: 58.54–85.23%). The factors associated with good adherence to option B plus PMTCT program were partner support (Adjusted odds ratio (AOR) = 4.13; 95% CI: 2.78–6.15), received counseling services (AOR = 4.12, 95% CI: 2.81–6.02), disclosure of HIV status to partner (AOR = 4.38; 95% CI: 1.79–10.70), and clinical stage of HIV/AIDS I/II (AOR = 2.62; 95% CI: 1.53–4.46).ConclusionThe level of adherence to option B plus program in Eastern African countries was generally sub-optimal. Thus, a coordinated effort is needed to raise the number of mothers to be tested, and early treatment initiation for HIV positive mothers before the disease advances. Furthermore, counseling services for couples on the importance of early treatment initiation and adherence to medications must be given due attention.
Highlights
Despite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers’ adherence to option B plus is still a challenge
Search strategy This review was conducted to measure the pooled magnitude of adherence to Option B plus antiretroviral therapy and associated factors among mothers on the PMTCT program in Eastern African countries
23 studies were assessed and screened for eligibility criteria based on the outcome variables related to antiretroviral therapy (ART) adherence of option B plus among which nine articles were excluded because of non-relevance to the current review
Summary
Despite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers’ adherence to option B plus is still a challenge. In option A, HIV positive pregnant mothers should start triple ARV medication as soon as diagnosed or as early as 14 weeks of gestation and continue until 7 days of postpartum or for life, based on their CD4 count. In option B, HIV positive pregnant mothers should start triple ARV medication as soon as diagnosed or at the early fourteenth week of gestation and continue until childbirth if not breastfeeding or until 1 week after cessation of breastfeeding or for life, based on their CD4 count [5]. The third approach was option B plus which was first conceived and implemented in Malawi in 2011 and is being used in many countries, including Eastern African countries like Ethiopia, Kenya, Uganda, and Tanzania, to mention a few This option recommends all HIV positive pregnant women to be given a life-long ART, irrespective of CD4 count starting as soon as diagnosed. Unlike the previous two options, option B plus played a crucial role in early ART initiation and reduction of sexual transmissions among serodiscordant partners [6,7,8]
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