Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

Cedrina L Calder; Heather O'Hara; Mohammad Tabatabai; Celia J Maxwell; Salisha Marryshow; Aima A Ahonkhai; Carolyn M Audet; C William Wester; Muktar H Aliyu

doi:10.21106/ijma.327

Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

Int J MCH AIDS. 2020;9(1):81-92. doi: 10.21106/ijma.327. Epub 2020 Jan 12.

Authors

Cedrina L Calder¹, Heather O'Hara¹, Mohammad Tabatabai², Celia J Maxwell³, Salisha Marryshow⁴, Aima A Ahonkhai⁵, Carolyn M Audet⁶, C William Wester⁵, Muktar H Aliyu⁶

Affiliations

¹ Meharry Medical College, School of Medicine, Department of Family and Community Medicine, Nashville, TN, USA.
² Meharry Medical College, School of Graduate Studies and Research, Department of Biostatistics, Nashville, TN, USA.
³ Howard University Hospital, Department of Medicine, Washington, DC, USA.
⁴ Vanderbilt University Medical Center, Institute for Medicine and Public Health, Nashville, TN, USA.
⁵ Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Department of Medicine, Nashville, TN, USA.
⁶ Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Department of Health Policy, Nashville, TN, USA.

Abstract

Objective: Adherence to combination antiretroviral therapy (ART) among pregnant women is essential to attaining the goal of eliminating mother-to-child HIV transmission. The objective of this study was to determine which factors affect adherence to ART among HIV-positive women enrolled in a large prevention of mother-to-child HIV transmission (PMTCT) trial in rural north-central Nigeria.

Methods: The parent study included 372 HIV-positive pregnant women enrolled in a cluster-randomized control trial conducted at 12 health facilities in Nigeria between 2013 and 2015. This secondary analysis included HIV-positive women (and their infants) from the original trial with documented adherence data (n=210, 56.5%). The primary outcome was maternal adherence to ART, determined by self-report and based on the visual analogue scale (VAS) of a validated medication adherence tool. Participants with a VAS score of ≥ 95% were classified as adherent. We employed multivariate logistic regression to evaluate the predictors of maternal ART adherence in the study sample.

Results: Approximately 61.0% of study participants (128/210) were adherent to ART. The majority of adherent participants (62.5%, 80/128) were enrolled in the trial intervention arm. The most common cited response for non-adherence was fear of status disclosure. Adherence to ART was associated with study arm (intervention arm vs. control arm, adjusted Odds Ratio (aOR) [95% CI]: 16.95 [5.30-54.23]), maternal ethnicity (Gwari vs. Other, aOR = 0.13 [0.05-0.38]), and partner HIV status (HIV-positive vs. unknown, aOR = 3.14 [1.22-8.07]).

Conclusion and global health implications: Adherence to ART among a cohort of pregnant women enrolled in a PMTCT trial in rural North-Central Nigeria was associated with trial arm, maternal self-reported ethnicity, and partner's HIV status. Increased understanding of the interplay between these factors will enable the development of more targeted and effective interventions.

Keywords: Adherence; Combination antiretroviral therapy; HIV/AIDS; Nigeria; PMCTC; PMTCT.

Abstract

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