Adherence to Antiretroviral Therapy (ART) Among HIV Positive Women at Antiretroviral Centers in Tema

Abstract

Introduction: Sub-optimal adherence is known to be one of the most common causes of poor treatment outcomes and /or lack of sustained treatment benefits. In the use of ARVs for the management of HIV infection in PMTCT, adherence is key for therapeutic success to be achieved and to ensure undetectable viral load at time of delivery. This reduces the risk of HIV transmission to the infant. In 2011, HIV/AIDS estimation for Ghana indicated that 2,933 babies were infected with HIV through vertical transmission. It is unclear how many of these mothers were on ART and the adherence levels among mothers of these children. Objective: The main objective of the study was therefore to determine the levels of adherence and assess the factors affecting adherence to Anti-retroviral therapy in PMTCT. Methods: This was a cross -sectional study which was carried out at the two ART centers offering comprehensive PMTCT programs in Tema; Tema General Hospital and Tema Polyclinic. Purposive sampling was used to collect quantitative data using a structured questionnaire for 141 HIV positive pregnant and breastfeeding women on PMTCT and an interview guide was used to conduct 10 in-depth interviews with these women who had been on ARVs for at least one month and attended clinic between May and June 2012. A chi-test was performed to compare adherence levels and logistic regression was used in assessing the determinants of adherenceThe level of optimal adherence measured as ≥95% for 7-day recall self reported adherence was 85.1% followed by one month visual analogue scale recall of 75.2%. The one month pill count recorded the least adherence level of 63.1%. Results: Sharing pills (OR=0.054, p<0.016) was found to be the factor that affected optimal adherence. In the qualitative study, the desire to live longer and be strong to take care of family was the most expressed factors that motivated adherence. Adherence levels were lower in pregnant and breastfeeding women who had no formal education, lived very far from the facility, shared pills with a family member and had a relative to remind them to take their pills. Conclusion: Sharing pills negatively affects adherence to ART. There is the need to review the content of pre-adherence counseling and to promote post-adherence counseling for women on ART for PMTCT to help ensure optimal levels of adherence to therapy.