The syndemic effects of mental ill health, household hunger, and intimate partner violence on adherence to antiretroviral therapy among pregnant women living with HIV in Yaoundé, Cameroon

Evette Cordoba,Claudian Soffo,John A Gallis,Jennifer Headley,Berenger Tchatchou,John Hembling,Angela M Parcesepe,Joy Noel Baumgartner,Yukiko Washio

doi:10.1371/journal.pone.0246467

Abstract

BackgroundThis research advances understanding of interrelationships among three barriers to adherence to antiretroviral therapy (ART) among pregnant women living with HIV (WLWH) in Cameroon: probable common mental disorders (CMD), intimate partner violence (IPV), and hunger.MethodsThe sample included 220 pregnant WLWH in Cameroon. Multivariable modified Poisson regression was conducted to assess the relationship between IPV, hunger, and CMD on ART adherence.ResultsAlmost half (44%) of participants recently missed/mistimed an ART dose. Probable CMD was associated with greater risk of missed/mistimed ART dose (aRR 1.5 [95% CI 1.1, 1.9]). Hunger was associated with greater risk of missed/mistimed ART dose among those who reported IPV (aRR 1.9 [95% CI 1.2, 2.8]), but not among those who did not (aRR 0.8 [95% CI 0.2, 2.3]).ConclusionSuboptimal ART adherence, CMD, and IPV were common among pregnant WLWH in Cameroon. Pregnant WLWH experiencing IPV and hunger may be especially vulnerable to suboptimal ART adherence.

Highlights

The World Health Organization (WHO) recommends lifelong antiretroviral therapy (ART) treatment for all pregnant women living with HIV (WLWH), a strategy known as Option B+ [1, 2]
Hunger was associated with greater risk of missed/mistimed ART dose among those who reported intimate partner violence (IPV), but not among those who did not
Hunger, and ART adherence among pregnant women living with HIV

Summary

Introduction

The World Health Organization (WHO) recommends lifelong ART treatment for all pregnant women living with HIV (WLWH), a strategy known as Option B+ [1, 2]. Suboptimal ART adherence among pregnant WLWH persists throughout sub-Saharan Africa [3, 4]. While most pregnant WLWH in Cameroon have access to ART, suboptimal ART adherence remains high [7, 8]. Major barriers to optimal ART adherence persist among pregnant WLWH in sub-Saharan Africa [9, 10]. This research advances understanding of interrelationships among three barriers to adherence to antiretroviral therapy (ART) among pregnant women living with HIV (WLWH) in Cameroon: probable common mental disorders (CMD), intimate partner violence (IPV), and hunger

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