PREVALENCE AND DETERMINANTS OF ANTIRETROVIRAL THERAPY ADHERENCE AMONG HIV POSITIVE WOMEN ACCESSING PREVENTION OF MOTHER TO CHILD TRANSMISSION SERVICES IN IBADAN, OYO STATE

Abstract

Globally, mother-to-child transmission (MTCT) of HIV infection is responsible for over 90% of the more than two million pediatric HIV. Nigeria has the highest number of children acquiring HIV through MTCT with an estimated 60,000 pediatric HIV infections annually. Adherence to Antiretroviral Therapy (ART) in pregnancy is important in the prevention of mother-to-child transmission (PMTCT) of HIV. This study investigated the prevalence and determinants of ART adherence, particularly the effect of HIV treatment adherence self-efficacy, among HIV positive women accessing Prevention of Mother-to-Child Transmission services in Ibadan, Oyo State. A cross-sectional study was conducted in which one hundred and twenty-six HIV positive pregnant women were recruited from three PMTCT facilities within the Ibadan metropolis. A mixed method study was employed. A pre-tested interviewer-administered questionnaire, two focus-group discussions among respondents and five key-informant interviews among PMTCT service providers were conducted and audio-recorded. Information on sociodemographic characteristics and obstetric characteristics were obtained. Respondents' knowledge on modes of HIV transmission, PMTCT and ART were assessed and a score of < 15 out of 20 indicated poor knowledge. HIV treatment adherence self-efficacy was assessed using the 12-item HIV Treatment-Adherence Self-Efficacy Scale (HIV-ASES) with a score of ≥15 out of 24 indicating low self-efficacy. Adherence levels were also assessed using the Center for Adherence Support Evaluation (CASE) Index Tool and a CASE score of ≥11 out of 16 indicated poor adherence. Quantitative data were analyzed using Descriptive Statistics, Chi-square and Logistic Regression at 5% significance level while thematic content analysis was used to analyze qualitative data. Mean age of respondents was 32.7 ± 4.58 years and mean gestational age was 24.4 weeks ±7.41 weeks. Sixty-two (49.2%) women commenced ART treatment before pregnancy and 81 (64.3%) had no previous PMTCT experience. A hundred and three (81.7%) women had a good knowledge of the modes of HIV transmission, 104 (82.5%) had good knowledge of mother-to-child transmission of HIV and l 09 (86.5%) had good knowledge on function of ART. Thirty-three (26.2%) women had a low HIV Treatment-Adherence Self-efficacy score. Eighty-nine (70.6%) women had good ART-adherence and 20 (15.9%) reported missing at least one dose in the week before the interview. After adjusting for confounders, monthly income (OR=0.3, 95%CI=0.08-0.98, P<0.05), parity (OR=0.2, 95%Cl=0.06-0.95, P<0.05), gestational age >20 weeks (OR=0.3, 95%Cl=0.07-0.93, P<0.05), knowledge of HIV transmission (OR=4.9, 95%Cl=1.29-18.50 , P<0.05), planned pregnancy (OR=4.6, Cl=1.36-15.79, P<0.05) and self-efficacy (OR=0.2, 95%Cl=0.05- 0.53, P<0.05) remained statistically significantly associated with ART adherence. Qualitative analysis showed that few women reported drug side-effects as barriers to ART adherence during ART initiation and looking healthier and protecting their unborn babies were motivators to adherence. Key informants reported that ART adherence was better in pregnancy compared with other periods because women wanted to prevent HIV-transmission to their unborn child. Stigmatization and negative spousal influences were barriers to ART adherence. The study identified that low HIV treatment adherence self-efficacy was related to poor ART adherence in pregnancy. Interventions aimed at improving ART adherence in pregnancy should focus on HIV treatment adherence self-efficacy.