Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland

Abstract

Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 -5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 -10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented. Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland Prior to 2013, antiretroviral therapy (ART) was recommended by the World Health Organization (WHO) for HIV-infected pregnant women with CD4 cell counts of <350 cells/µL or those who were at WHO clinical stage III or IV Women who did not meet these criteria,were advised to use one of two options. Option A: antepartum zidovudine, with single-dose nevirapine during labour, and a 7-day zidovudine/lamivudine 'tail' alongside daily infant nevirapine during breastfeeding. Option B: ART during pregnancy and through cessation of breastfeeding to prevent mother-to-child HIV transmission (PMTCT.) [1] Many countries, including Swaziland, chose to implement option A; a CD4 cell count was performed on all women identified to have HIV infection to determine those who should be initiated on life-long ART for both maternal health and PMTCT. In Swaziland, 88% of facilities that provide antenatal care (ANC) services also provide PMTCT services.[2] In 2009, 73% of women attending ANC facilities were tested for HIV, and 88% of HIV-infected pregnant women received a complete course of PMTCT prophylaxis in 2009. [3] However, a review of the data in the Early Infant Diagnosis (EID) database in Swaziland at the time of the introduction of option A guidelines, showed that ~50% of HIV-infected women who were eligible for ART actu...

Simplified clinical algorithm for immediate antiretroviral therapy initiation

“…Immediate ART initiation is one of the keys to controlling the HIV epidemic by reducing the morbidity and mortality of patients and minimizing the risk of transmission in the community. Various conditions, however, influence and can be barriers to ART uptake, such as readiness to start life-long treatment 24 , 25 , the concern of adverse effects 26 , the experience of criminalization among PWID 27 , the presence of informal peer network, community-based organization, outreach workers and fear of stigma 14 , 15 . Other than these clinical or structural factors may also influence ART uptake, such as inefficient multi-step process 12 , geography, type of healthcare facility (primary vs .…”