Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

Oladele Vincent Adeniyi; Anthony Idowu Ajayi

doi:10.1371/journal.pone.0229592

Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

PLoS One. 2020 Feb 27;15(2):e0229592. doi: 10.1371/journal.pone.0229592. eCollection 2020.

Authors

Oladele Vincent Adeniyi¹, Anthony Idowu Ajayi²

Affiliations

¹ Department of Family Medicine & Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha/East London Hospital Complex, Cecilia Makiwane Hospital, East London, South Africa.
² Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, APHRC Campus, Manga Close, Nairobi, Kenya.

Abstract

Background: Adherence to antiretroviral therapy (ART), especially during the postpartum period, remains a major challenge in the efforts towards eliminating mother-to-child transmission of HIV. This study examined the levels and determinants of postpartum adherence to ART among mothers with HIV in the Eastern Cape, South Africa.

Methods: In this cross-sectional analytical study, we interviewed 495 postpartum women with HIV between January and May 2018. We measured postpartum adherence using six questions probing participants' adherence behaviours since child birth. We categorised the adherence behaviours into complete adherence (mothers who reported no missed episode(s) of ART since child birth) and suboptimal adherence (mothers with any missed episode(s) of ART). Adjusted and unadjusted logistic regression models were used to examine the determinants of postpartum adherence to ART.

Results: Overall, 63.9% reported complete adherence during the postpartum period but the rates varied by socio-demographic and behavioural characteristics. The adjusted logistic regression analysis showed that younger mothers were 70% less likely to report complete adherence to ART compared to mothers aged 40 and above. Likewise, mothers who currently use alcohol were 53% less likely to report complete postpartum adherence to ART compared to those who did not use alcohol. However, mothers who knew their partner's status were twice more likely to report complete postpartum adherence compared to those who did not. There was no statistically significant relationship between ART adherence and breastfeeding durations.

Conclusion: Postpartum adherence to ART is suboptimal in the study setting, and younger mothers and those who use alcohol have a lower odds of complete adherence. Knowing a partner's status improves adherence, but infant feeding practices did not influence postpartum adherence behaviours. It is critical to design and strengthen interventions which target young mothers and alcohol users. Also, HIV sero-status disclosure should be encouraged among mothers to facilitate partner support.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-HIV Agents / therapeutic use*
Cohort Studies
Cross-Sectional Studies
Female
HIV Infections / complications*
HIV Infections / drug therapy*
HIV Infections / transmission
Humans
Infectious Disease Transmission, Vertical / prevention & control
Logistic Models
Medication Adherence* / statistics & numerical data
Postpartum Period
Pregnancy
Pregnancy Complications, Infectious / drug therapy*
Prospective Studies
South Africa
Surveys and Questionnaires
Young Adult

Substances

Anti-HIV Agents

Grants and funding

OVA is a receipient of the South African Medical Research Council Pilot Grant awarded to Walter Sisulu University. Research reported in this publication was supported by the South African AIDS Vaccine Initiative under the auspices of the South African Medical Research Council with funds received from the South African National Department of Health.