MALE INVOLVEMENT AND INFLUENCE ON ADHERENCE TO ANTI-RETROVIRAL THERAPY AMONG HIV POSITIVE WOMEN ATTENDING ANTENATAL CLINIC IN EGBE, KOGI STATE

Abstract

Mother-to-child transmission of HIV (MTCT) is responsible for 90.0% of new paediatric infections. Prevention of mother-to-child transmission of HIV (PMTCT) is a major strategy targeted at reducing paediatric HIV infections. However, adherence to antiretroviral therapy (ART) is poorer among HIV positive women who lack social support especially from their male partner. Thus, the success or PMTCT services is largely hinged on male partner participation. Male involvement in the utilization of PMTCT services in Kogi State is widely undocumented. Therefore, this study was carried out to assess male involvement in the utilization of PMTCT services and its influence on adherence to antiretroviral therapy (ART) by HIV positive women attending ECWA Hospital, Egbe, Kogi State. This study was a cross- sectional survey which employed mixed methods of data collection from HIV-positive women attending antenatal and postnatal clinic. A two-stage random sampling technique was used to select three facilities out of seven public secondary health facilities within Kogi West and Central Senatorial district. Purposive sampling was used to serially recruit three hundred and ninety-nine (399) respondents attending PMTCT programme in all selected health facilities (355 HIV positive pregnant women and 44 positive women within early postpartum period). A pre-tested interviewer administered questionnaire was used to obtain information on socio-demographic characteristics, male involvement, adherence to ART and factors influencing male involvement in PMTCT utilization. A 12- point ad-hoc male involvement index was used to determine overall male involvement. Male involvement scores of 0 was classified as none, 1-5 as low and >6 as high. Scores of <2 and ≥ 2 were classified as low and high adherence due to male involvement respectively. Data were analyzed using descriptive statistics, Chi-square and logistic regression at p=0.05. Age of respondents was 33.8±7.6 years and mean age in marriage was 8.2±6.8 years with monogamy (82.5%) as the commonest type of marriage. About 60.5% had at least secondary education and (67.2%) were from urban and semi-urban areas. Only 85.2% of the respondents were employed while 88.7% of their male partners were employed. Good knowledge of MTCT and PMTCT was reported by 63.9% of the respondents, and their main source of information was from health workers (79.6%). About 69.2% of male partners had couple testing for HIV together with spouse during pregnancy. Concordant couple (28.1%) is currently on antiretroviral therapy whereas discordant couples were 71.9%. Only 84.2% of the respondents have disclosed their HIV status to their partners. About 38.9% of male partners do no accompany spouse to PMTCT clinic due to partner not aware of their HIV status. Respondents currently on ART are 95 .5%. Most 51.9% of the respondents commenced ART treatment during pregnancy whereas only 48.1 % had their ART initiation during Labor/delivery and early post-partum. Only 18.8% of the HIV positive women had previous PMTCT experience. About 84.2% knew their partner HIV status, 83.7% and 84.7% supported financially on PMTCT clinic and jointly planned current pregnancy partners respectively, 74.7% of husbands were willing to bought formula milk for their babies, 81.0% reminded spouse to take ART drug. Male involvement in ART adherence was high (81.0%). Most (60.2%) respondents attained good ART adherence due to male partner involvement. and reasons for missing medication included being away from home and forgetfulness. Family disharmony 10.8% and pregnancy related problems 10.8% represents mostly reported reasons male partners restrict their spouse from taking ART drugs. Women who are currently married were four times more likely to have good ART adherence due to male partner involvement than the previously married and the single (AOR = 5.3, 95% Cl : 2.4, 11.7, p< 0.001). Spouse's in ART group were about three times more likely to be involved in ART adherence due to male partner participation than those who are not in their spouse's group (AOR = 2.7, 95% CI: 1.30, 5.38 p= 0.004) . Spouse of discordant couples were two times more likely to achieved good ART adherence o f ≥95% optimal adherence due to male partner involvement than those of concordant couples (AOR = 0.7, 95% CI: 0.43 , 1.12, p= 0.133). Male partners involvement in antiretroviral therapy (ART) uptake was found to be associated with high adherence. Policies that integrates male partners in the ca re of HIV positive women may improve adherence to antiretroviral therapy (ART).