The magnitude of adherence to option B plus program and associated factors among women in eastern African countries: a systematic review and meta-analysis

Abstract

Background Despite coverage and benefits associated with the prevention of mothers to child transmission (PMTCT) services, mothers’ adherence to option B plus is still a challenge. Though few primary studies are available on the magnitude of adherence to option B plus and factors associated in Eastern African countries, they do not provide strong evidence in helping policymakers to address suboptimal adherence to option B plus. Therefore, this systematic review and meta-analysis was intended to estimate the pooled magnitude of adherence to option B plus program and associated factors among women in Eastern African countries. Methods PubMed, Medline, HINARI, Cochrane library, the Web of Science, and Google Scholar were searched for studies reported on the magnitude of adherence to option B plus among women in Eastern African countries. The search terms used were “option B plus”, “magnitude”, “prevalence”, “PMTCT”, “ART adherence”, “associated factors”, “all lists of Eastern African countries” and their combination by Boolean operators. The effect sizes of the meta-analysis were the magnitude of adherence to option B plus and the odds ratio of the associated factors. STATA/SE V14 was used for statistical analysis, and publication bias was assessed using funnel plots and Egger’s test. Results Fourteen studies having total participants of 4883 were included in the systematic review and meta-analysis. Using the random effect model, the pooled prevalence of adherence to option B plus was 71.88% (95% CI: 58.54–85.23%). The factors associated with good adherence to option B plus PMTCT program were partner support (Adjusted odds ratio (AOR) = 4.13; 95% CI: 2.78–6.15), received counseling services (AOR = 4.12, 95% CI: 2.81–6.02), disclosure of HIV status to partner (AOR = 4.38; 95% CI: 1.79–10.70), and clinical stage of HIV/AIDS I/II (AOR = 2.62; 95% CI: 1.53–4.46). Conclusion The level of adherence to option B plus program in Eastern African countries was generally sub-optimal. Thus, a coordinated effort is needed to raise the number of mothers to be tested, and early treatment initiation for HIV positive mothers before the disease advances. Furthermore, counseling services for couples on the importance of early treatment initiation and adherence to medications must be given due attention.

Adherence to option B+ PMTCT program and its predictors among HIV‐positive women in Ethiopia. A systematic review and meta‐analysis

“…This could be partly due to the impact of biological, social, and economic challenges associated with pregnancy and lactation 39 . However, the estimate is higher than the finding of a previous meta‐analysis conducted in eastern Africa 11 . The possible explanation for this variation could be the difference in number, setting, and design of included primary studies.…”

“…Consequently, women who disclosed their sero-status were 2.58 times more likely to adhere to the regimen as compared to women who did not disclose. This association is documented elsewhere, 11,17,40 and could be because disclosing their sero-status encourages women to ask for and receive support from their partners and/ or families. 9,40 The odds of adherence were about five times higher among women who were counseled on the importance of PMTC and possible drug side effects than those women who were not.…”

“…This finding was also revealed by previous reports. 11,41 The conceivable reason could be that counseling on the benefit of PMTCT and possible drug side effects increases clients' trust in health care providers and creates opportunities to clarify ambiguities. 42 In line with previous studies, our analysis found that educational status was significantly associated with adherence to PMTCT.…”

“…A recent nationwide analysis in Burkina Faso found that 14% of pregnant and breastfeeding women were nonadherent to ART 10 . Moreover, a meta‐analysis of east African studies also revealed that more than one‐fourth of women were nonadherent to option B+ PMTCT 11 . In Ethiopia, the rate of poor adherence to option B+ PMTCT ranges from 5% to 32.7%, 12–14 nonetheless there is a paucity of conclusive evidence at the national level.…”

Antiretroviral Therapy Adherence During and Postbreastfeeding Cessation Measured by Tenofovir Levels in Hair

“…1 Adherence to antiretroviral treatment (ART) can reduce the risk of perinatal transmission to almost zero and benefit maternal health. [2][3][4] Despite accessing universal ART, women can experience significant challenges to adherence and engagement to HIV care, [5][6][7][8] with 20%-40% of women experiencing elevated viral loads postpartum. [9][10][11] Breastfeeding cessation may be critical juncture when intense contact with the health care system ends.…”