Factors associated with antiretroviral therapy use among pregnant women in rural and urban settings in Southern Province, Zambia: 2016–2019

Abstract

Objectives To assess antiretroviral therapy (ART) coverage among pregnant women living with HIV and compare the characteristics of women who received and did not receive ART during pregnancy in Zambia. Methods A cross‐sectional study was conducted at urban and rural health facilities in Southern Province, Zambia, from 2016 to 2019. Pregnant women living with HIV delivering at study sites were enrolled and administered a questionnaire, and the results of infant diagnostic testing for HIV at birth was documented. Results About 1184 mother/infant pairs were enrolled. ART coverage was 93.7%. Most women who did not receive ART during pregnancy reported HIV diagnosis at delivery (18.0%) or during pregnancy (57.7%). The primary reported reason for not receiving ART was not wanting to take the drugs. Women who did not receive ART during pregnancy were significantly younger, less likely to have disclosed their HIV‐infection status to others, and less likely to have received antenatal care than women who received ART. ART use correlated with higher levels of education in urban but not rural sites. Overall, 1.0% of infants were infected with HIV at birth, including 0.8% of infants born to women who received ART and 4.1% of infants born to women who did not. Conclusions Most women received ART according to guidelines, resulting in low perinatal transmission rates of HIV to infants. Efforts to increase ART coverage and prevent vertical transmission should focus on identifying incident HIV infections during pregnancy and strengthening counselling for newly diagnosed pregnant women.

The Evolving Pediatric HIV Epidemic in Rural Southern Zambia: The Beneficial Impact of Advances in Prevention and Treatment at a District Hospital From 2007 to 2019

“…A large study of pregnant women living with HIV in Southern Province found that women who did not receive ART were younger, more likely to be diagnosed with HIV during pregnancy, and less likely to have disclosed their status to their partner or received antenatal care. 25 Increased efforts to ensure repeated testing during pregnancy and counseling for women newly diagnosed with HIV during pregnancy, as well as potential inclusion of pre-exposure prophylaxis in services offered to pregnant women, may be needed to further reduce new pediatric infections.…”

Understanding the uptake and determinants of prevention of mother-to-child transmission of HIV services in East Africa: Mixed methods systematic review and meta-analysis

“…Studies worldwide have reported factors that have an association with maternal HIV test and ART services uptake, including place of residence [24][25][26], education level [24,[26][27][28], maternal age [26,27], knowledge of HIV/AIDS and PMTCT [27,29,30], SES [24,26,31,32], lack of privacy and confidentiality [33], women's decision-making capacity [29,34,35], prenatal care [26,31], fear of disclosure and stigma [30,[36][37][38][39]. Likewise, factors such as distance from a health facility [40], partner/family support [39], denial of HIV status [41], shortages of resources [41,42], lack of knowledge [43], feelings of guilt [43], children of known HIV positive fathers [44] and maternal receipt of ART/HAART [40,43,45] have also been reported to affect infant ARV prophylaxis and EID services uptake.…”