Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review

Abstract

BackgroundThe use of antiretroviral therapy (ART) is a core strategy proposed by the World Health Organization in preventing mother to child transmission (MTCT) of HIV. This systematic review aimed to examine the enablers and barriers of medication adherence among HIV positive pregnant women in sub-Saharan Africa.MethodsWe used the following keywords: HIV AND (Pregnancy OR Pregnant*) AND (PMTCT OR “PMTCT Cascade” OR “Vertical Transmission” OR “Mother-to-Child”) AND (Prevent OR Prevention) AND (HAART OR “Antiretroviral Therapy” OR “Triple Therapy”) AND (Retention OR Concordance OR Adherence OR Compliance) to conduct electronic searches in the following databases: MEDLINE Complete (1916-Dec 2017), Embase (1947-Dec 2017), Global Health (1910-Dec 2017) and CINAHL Complete (1937-Dec 2017). Of the four databases searched, 401 studies were identified with 44 meeting the inclusion criteria. Seven studies were added after searching reference lists of included articles, resulting in 51 articles in total.ResultsThe review demonstrated that stigma, cost of transportation, food deprivation and a woman’s disclosure or non-disclosure of her HIV status to a partner, family and the community, could limit or define the extent of her adherence to prescribed antiretroviral drugs during pregnancy. Furthermore, the review indicated that knowledge of HIV status, either before or during pregnancy, was significantly associated with medication adherence. Women who knew their HIV status before pregnancy demonstrated good adherence while women who found out their HIV infection status during pregnancy were linked with non-adherence to ART.ConclusionThis review revealed several barriers and enablers of adherence among pregnant women taking ART in sub-Saharan Africa. Major barriers included the fear of HIV infection status disclosure to partners and family members, stigma and discrimination. A major enabler of adherence in women taking ART was women’s knowledge of their HIV status prior to becoming pregnant. Enhanced effort is needed to facilitate women’s knowledge of their HIV status before pregnancy to enable disease acceptance and management, and to support pregnant women and her partner and family in dealing with fear, stigma and discrimination about HIV.

“At home, no one knows”: A qualitative study of retention challenges among women living with HIV in Tanzania

“…Stigma is a prominent barrier to the success of HIV prevention and treatment programs in the general population. Likewise, women enrolled in PMTCT services are negatively impacted by stigma at each step of the care continuum [12,21,[24][25][26][27][28]. Furthermore, the pregnancy adds another layer of vulnerability, especially for women who rely on their partners for financial support.…”

Time of HIV diagnosis, CD4 count and viral load at antenatal care start and delivery in South Africa

“…Currently, the risks of post-partum virologic failure and retention in care in the UTT era are unclear. Nevertheless, these results highlight the benefit of expanding pre-pregnancy ART access to women in higher CD4 count groups in ensuring safer pregnancies [32]. These results not only highlight the importance of intensifying pre-pregnancy diagnosis and ART initiation but also the need to expand adherence support to improve and sustain viral suppression among women who start ART in-pregnancy.…”

“…Among women who started pre-pregnancy ART, promoters of VL suppression at entry into ANC were seeking employment, being a first-time mother and being married. The association between viral suppression at entry into ANC with unemployment and being married highlight the need for free time and partner/social support in seeking HIV care and ART adherence [31,32].…”

<p>Adherence to Option B⁺ Care for the Prevention of Mother-to-Child Transmission Among Pregnant Women in Ethiopia</p>

“…This finding is supported by studies conducted in other countries. [30][31][32][33] This might be is because clients with a favorable attitude towards health services have better healthcare-seeking behavior that helps them stick to their prescribed medication and recommendation given from healthcare workers.…”