Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health: experiences from the Mitra Plus study in Tanzania

Abstract

BackgroundIn a study of prevention of mother-to-child transmission of HIV (PMTCT) by triple antiretroviral therapy (ART) in Dar es Salaam, Tanzania (the Mitra Plus study), retrospective viral load testing revealed a high and increasing frequency of detectable viral load during follow-up for two years postnatally in women given continuous ART for their own health suggesting poor adherence. This study explored women’s own perceived barriers to adherence to ART post-delivery so as to identify ways to facilitate better drug adherence among women in need of ART for their own health.MethodsSemi-structured interviews were conducted with 23 of the 48 women who had detectable viral load at 24 months postnatally. Content analysis was used to analyze the data.ResultsMost women in the study did not acknowledge poor adherence until confronted with the viral load figures. Then, however, they revealed multiple reasons for failing to adhere. They said that their motivation to take ART decreased once they had protected their children from becoming infected and successfully weaned them. Feeling well for some, and a feeling of hopelessness for others, also decreased motivation to continue ART. The overwhelming demands of everyday life, poverty and lack of empowerment also posed significant barriers to long-term adherence. The need to keep their HIV status a secret and not let anyone see them taking the drugs was another steep barrier.ConclusionReasons for postnatal failure to adhere by mothers put on ART for life during pregnancy included lack of motivation to continue ART after weaning the child, poverty and stigma. Projects that simultaneously address stigma, poverty and women’s lack of empowerment may be necessary for PMTCT and ART to reach their full potential. Our results indicate that the new WHO proposal to start all HIV-infected pregnant women on lifelong ART regardless of CD4 cell count needs to address the challenging realities of women in resource-poor contexts if it is to be successful.

Uptake of Services for Prevention for Mother-to-Child Transmission of HIV in Lubumbashi (D.R. of Congo)

“…This prevalence is lower than that found by Ngarina et al [12] in Lubumbashi (4.15%), Ndege et al [13] in Kenya (3.3%), Gamell et al [14] in Tanzania (2.6%), Musarandega et al [15] in Zimbabwe (16.3%) and Tenthani et al [16] in Malawi (12.8%). The impact of HIV/AIDS observed could explain the discrepancy in these countries.…”

“…From these results, we find that almost 50% of pregnant women who receiving antenatal care have not been screened, which would contribute to an increase in the proportion of pregnant women giving birth with an unknown HIV serological status. Some authors have noted factors explaining this finding, namely the lack of education and information among pregnant women, fear of stigmatization and potential marital collapse; absence or poor involvement of the partner to the program, the conduct of the PMTCT program that doesn't allow clinical management in a humanizing manner [10][11][12].…”

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

“…The size and smell of the tablets, taking the medication without an assurance of a meal, and the anticipated side effects are some of the reasons mothers stopped taking the ARVs, hence selfcensoring themselves from coming to the clinic. Studies have also shown that poor adherence to drugs is attributed to the feared side effects [15] and food insecurity [16,17]. Health Education coupled with initial and ongoing HIV and adherence counseling especially with the help of peers will help dispel the myths that are associated with the taking of medication.…”

Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships

“…Patient-level barriers to ART initiation are often similar to adherence barriers and include denial of the need to start treatment, lack of motivation to stay on treatment, fear of side effects, lack of social support, stigma, fear of disclosure, and the perception that starting ART signifies AIDS and impending mortality. 41,[46][47][48][49][50][51][52] Lower mental health scores were the only psychosocial variable significantly associated with poor adherence in a randomized trial of ART for HIV-1 prevention (HPTN 052). 53 These factors may influence adherence during the initial period after ART initiation, as well as subsequent virologic outcomes.…”