Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV Infected Women Utilizing Reproductive and Child Health Services at Bugando Hospital Mwanza Tanzania

Abstract

Background: In 2013, Tanzania adopted the WHO‟s Option B+, PMTCT guideline; whereby all HIV-infected pregnant and lactating women are initiated with lifelong ART. Previous studies have shown that drug-resistance is not the only cause of treatment failure but also Sub-optimal adherence; at the same time women with good adherence to ART have less than 5% chance of transmitting of HIV infection to their children compared to those with poor adherence where the risk rises up to 45%. Despite of the increasing coverage of elimination of MTCT in Tanzania, there is limited information focusing on the level of option B+ adherence and its covariates in the context rural and urban settings among pregnant and breastfeeding women on ART. In 2016, Mwanza region had a prevalence of HIV at 4.2% much lower than the current data of 2018 which is 7.2%, a significant change which may need more studies Aim: To determine the level of and factors influencing non-adherence to ART among HIV infected women utilizing PMTCT services in Bugando hospital in Mwanza, Tanzania. Methodology: An analytical study involving 378 HIV positive women attending reproductive and child health clinic in Bugando referral hospital between the months of February and March in the year 2020, at Bugando hospital Mwanza, Tanzania, voluntarily responded to a pre-tested questionnaire containing a semi structured questions and responses were analyzed by STATA 16. Results: Proportions of women with non-adherence were 5.6% with knowledge level on Option B+ being high for over 95% of the HIV positive women attending the clinic. women with older age were more likely to adhere to ART (aOR=8.2; 95% CI=1.8-36.3; p=0.02), pregnancy increased the odds of adherence to ART when compared to the non-pregnant women (aOR=4.9; 95% CI=1.9-12.7; p=0.006), those with secondary school education or higher were more likely to have adherence levels of above 95%( aOR=4.4; 95% CI=1.0-19; p = 0.05) and women with high knowledge on PMTC were more likely to have high adherence to ART when compared to those with low knowledge on PMTCT (aOR=3.8; 95% CI=0.9 - 15.6; p = 0.063) Although statistical significance was not strong, disclosing one‟s HIV status is associated with higher odds of having higher adherence (aOR=1.8; 95% CI=0.6-5.6; p=0.08) Conclusion: Participants‟ Age, education, pregnancy status and knowledge on PMTCT were directly related to and predicted the level of adherence in this study therefore adherence counseling focusing to improve knowledge on PMTCT could be more intensified for the young clients paying closer attention to non-pregnant RCH attendees and with less than secondary school education.