Longitudinal adherence to antiretroviral drugs for preventing mother-to-child transmission of HIV in Zambia

Abstract

BackgroundAdherence to antiretroviral (ARV) drugs is essential for eliminating new pediatric infections of human immunodeficiency virus (HIV). Since the Zambian government revised the national guidelines based on option A (i.e., maternal zidovudine and infant ARV prophylaxis) of the World Health Organization’s 2010 guidelines, no studies have assessed adherence to ARVs during pregnancy up to the postpartum period. This study aimed to examine adherence to ARVs and identify the associated risk factors.MethodsA prospective cohort study was conducted in the Chongwe district from June 2011 to January 2014. Self-reported adherence to ARVs was examined during pregnancy and at one week, six weeks, and 24 weeks postpartum among 321 HIV-positive women. The probability of remaining adherent to ARVs was estimated using the Kaplan-Meier method, and the risk factors for non-adherence were identified using the Cox proportional hazard regressions—treating loss to follow-up as non-adherence. The statuses of HIV in HIV-exposed infants were assessed in January 2014.ResultsDuring the study period, 326 infants were born to HIV-positive women, 262 (80.4 %) underwent HIV testing, and 11 (3.4 %) had their HIV infection detected at the time that they had the latest HIV testing as of January 2014. The ARV adherence rate was 82.5 % during pregnancy, 84.2 % at one week postpartum, 81.5 % at six weeks postpartum, and 70.5 % at 24 weeks postpartum. The probability of remaining adherent to ARVs was 0.61 at day 50, 0.35 at day 100, 0.18 at day 200, and 0.06 at day 300. Attending a referral health center (HC) was a risk factor for non-adherence compared with attending rural HCs that provided HIV care/treatment (adjusted hazard ratio [aHR] 0.71, 95 % confidence interval [CI] 0.57–0.88) and those that did not provide HIV care/treatment (aHR 0.58, 95 % CI 0.46–0.74). A new diagnosis of HIV infection compared to a known HIV-positive status before pregnancy was another risk factor for non-adherence (aHR 1.24, 95 % CI 1.03–1.50).ConclusionsMaintaining adherence to ARVs through pregnancy to the postpartum period remains a crucial challenge in Zambia. To maximize the treatment benefits, adherence to ARVs and retention in care should be improved at all health facilities.

Levels of adherence and factors associated with adherence to option B+ prevention of mother-to-child transmission among pregnant and lactating mothers in selected government health facilities of South Wollo Zone, Amhara Region, northeast Ethiopia, 2016

“…Similarly, studies have been performed to assess the adherence of pregnant and lactating mothers in Chongwe district, Zambia (82.5%), Nnewi, Nigeria (78.3%), and in a meta-analysis (73.5%) [9,16,19]. Socio-demographic factors may explain the discrepancies with our findings.…”

“…This finding is supported by studies carried out in Zambia and Malawi [19,20]. The potential reasons could include the poor quality of PMTCT services provided in hospitals due to a large number of PMTCT clients.…”

Adherence to Anti-retroviral Therapy among HIV Positive Pregnant Women in Ayder Refferal Hospital, Northern Ethiopia

“…This is higher than study reported in Nigeria (80.6%), Zambia (82.5%) and Malawi (72.5%) [8,9,17]. This might be due to good practice of PMTCT and awareness of the participants in the study area and having good regular follow up that increase the adherence rate in the study area.…”

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“…Two studies in Ilorin, Nigeria showed that adherence levels in the general HIV-patients population were high: 73.3% 29 A similar study in Zambia reported adherence rates of 82.5% pre-partum 33 . These results that are similar to that of this present study fit into the average of 75.7% adherence rate that was found to be the pre-partum rate in a meta-analysis 34 .…”