Comparison of level and predictors of adherence to art option b+ between HIV infected pregnant and lactating women at Mnazi Mmoja hospital Dar es salam Tanzania

Abstract

Background: Adherence to medication is a crucial component in the prevention of mother to child transmission of HIV. The prevention of mother to child transmission (PMTCT) program is an intervention that aims towards reduction of vertical transmission of HIV. It is obvious that without this intervention many babies would die within the first two years of life as evidenced by the fact that mother-child transmission account for 18% of new HIV infections and almost 99,000 HIV positive women deliver exposed infants annually in Tanzania. In line with the objectives of PMTCT to eliminate mother-to-child transmission through improvement of reproductive and child health (RCH) services the Ministry of Health, Community Development, Gender, Elderly and Children adopted option B plus PMTCT program since 2013. Aim: This study aimed to compare level and predictors of adherence to ART between HIV/AIDS infected pregnant and lactating women currently on Option B + regime. Methodology: This was a comparative cross-sectional study involving 338 participants of which 169 were pregnant and 169 were lactating women on Option B + regime attending PMTCT services at Mnazi Mmoja Hospital Dar es salaam. Data on adherence level were collected from patients by self-reporting method whereby a questionnaire which was adapted and modified from the tool to measure ART adherence in the resource constrained settings of South Africa, which contain the questions of Information- motivation and behavior skills (IMB) model was used. This IMB model postulates that health related information, motivation and behavior skills are important determinants of whether or not a health behavior is performed. The questionnaire was used to collect socio-demographic information, measures of drugs adherence, medical history and Obstetric history. Important variables were marital status, HIV disclosure status, economic status (measured by employment status), and distance from health facility, education level, gestational age and gravity. Data were analyzed using the Statistical Package for Social Sciences (SPSS) computer software, version 20. Data were presented by using descriptive summary statistics like proportions as well as logistic regression for determining association between dependent and explanatory variables. Results were considered of statistical significance when the p-value <0.05. Results: The overall proportion of good adherence to ART option B+ in this study was 58.9%, pregnant women were found to have good adherence (66.6%) than lactating mothers (51.0%). Controlling for the effect of other factors, the odds of adhering to ART Option B+ were 7 times higher among women who received good partner support as compared to those with poor partner support (AOR=7.2, 95% CI =1.01-14.22). Similarly, women with good knowledge on PMTCT were 2.5 times likely to have good adherence than those with poor knowledge (AOR 2.54(1.29-5.01). Disclosure status also has shown to influence adherence (AOR=1.07 95% CI =1.01 – 4.22) and participants who knew HIV status of their male partners were (COR=2.17, 95% CI=1.40-3.36) more likely to be adherent compared to those who did not know their male partner HIV status. When confounding factors were considered, knowing partner HIV status had no significant difference in adherence as compared to their counterpart (AOR=1.28, 95% CI=0.68-2.43). Comparatively, only three factors were found to influence adherence to option B+ in pregnant group of which being married, having good partner support and good knowledge on PMTCT significantly influenced adherence, in contrast to lactating women group in which more factors were observed such that being married, having good partner support, disclosing HIV status and knowing spouse HIV status and short duration after delivery significantly influenced adherence status. Conclusions : The overall proportion of good adherence to PMTCT option B+ in this study was 58.9%, pregnant women were found to have high level of good adherence (66.6%) than lactating mothers (51.0%). The main predictors influencing adherence were good male partner support, marital status, and good knowledge on PMTCT and, disclosure status.

Recommendations  Further studies multicenter with large sample size should be conducted as it will also help to find out the associations of multiple factors with adherence, together with the evaluation the components of counseling in relation with adherence.  Counseling should be intensive and comprehensive including all the components as recommended by ministry of health, including importance of disclosing own HIV status, knowing partner HIV status and adhering to ART.