Current status of medication adherence and infant follow up in the prevention of mother to child HIV transmission programme in Addis Ababa: a cohort study

Abstract

BackgroundPrevention of mother to child HIV transmission (PMTCT) programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed. This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme.MethodsA prospective cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa, Ethiopia. Descriptive statistics, bivariate and mulitivariate logistic regression analyses were done.ResultsOf 282 mothers enrolled in the cohort, 232 (82%, 95% CI 77-86%) initiated medication during pregnancy, 154 (64%) initiated combined zidovudine (ZDV) prophylaxis regimen while 78 (33%) were initiated lifelong antiretroviral treatment (ART). In total, 171 (60%, 95% CI 55-66%) mothers ingested medication during labour. Of the 221 live born infants (including two sets of twins), 191 (87%, 95% CI 81-90%) ingested ZDV and single-dose nevirapine (sdNVP) at birth. Of the 219 live births (twin births were counted once), 148 (68%, 95% CI 61-73%) mother-infant pairs ingested their medication at birth. Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery. Mother-infant pairs attended in health facilities at birth were more likely (OR 6.7 95% CI 2.90-21.65) to ingest their medication than those who were attended at home. Overall, 189 (86%, 95% CI 80-90%) infants were brought for first pentavalent vaccine and 115 (52%, 95% CI 45-58%) for early infant diagnosis at six-weeks postpartum. Among the infants brought for early diagnosis, 71 (32%, 95% CI 26-39%) had documented HIV test results and six (8.4%) were HIV positive.ConclusionsWe found a progressive decline in medication adherence across the perinatal period. There is a big gap between mediation initiated during pregnancy and actually ingested by the mother-infant pairs at birth. Follow up for HIV-exposed infants seem not to be organized and is inconsistent. In order to maximize effectiveness of the PMTCT programme, the rate of institutional delivery should be increased, the quality of obstetric services should be improved and missed opportunities to exposed infant follow up should be minimized.

Level of adherence and predictors of adherence to the Option B+ PMTCT programme in Tigray, northern Ethiopia

“…27,28 Disclosure of HIV status to their partner, the partner's involvement in HIV testing, and counselling on ARV drugs had no significant association with adherence in the study done in Addis Ababa. 29 Generally, HIV status disclosure is considered important in diminishing the transmission of HIV infection in HIV-negative male sexual partners (discordant couple), which is one of the additional benefits of Option B+ over options A and B. 8,12 This finding implies that stakeholders should also focus on male partners to optimize the benefits of Option B+ PMTCT care and support.…”

HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia

“…Previous research has found higher rates of defaulting from HIV care [33] and declines in ART adherence during the perinatal and post-delivery periods [34–36], which has been attributed to conflicting priorities of new mothers, less interaction with the healthcare system post-delivery, and postpartum depression [37]. Our finding may suggest that even before delivery, pregnant women’s belief in the need for long-term HIV care and treatment may be undercut by the belief in the curative power of Holy Water.…”

Delay in Early Infant Diagnosis and High Loss to Follow-Up among Infant Born to HIV-Infected Women in Ethiopia

“…Studies showed that about 20% of HIV-positive infants die before six months and 35% to 40% die before 12 months [6] [7]. EID is a crucial step to facilitate access to ART, to improve infants' survival and to augment the benefit of PMTCT programmes [6] [7]. Early initiation of ART was associated with better treatment outcomes and increased survival of children born to HIV infected mothers [8].…”

“…HIV screening is routinely offered to all women seeking prenatal care, and those who are HIV infected are offered antiretroviral (ARV) prophylaxis when eligible by national guidelines [11]. Although Ethiopian government-sponsored programs are available to provide care for all women, less than 20% received PMTCT in 2010 [7] [13]. Multiple factors, i.e., not seeking health care and high rate of loss to follow-up, lead to low rates of initiating medication during pregnancy and taking ARV at the time of birth.…”

“…Studies showed that about 20% of HIV-positive infants die before six months and 35% to 40% die before 12 months [6] [7]. EID is a crucial step to facilitate access to ART, to improve infants' survival and to augment the benefit of PMTCT programmes [6] [7].…”