scholarly journals Self-efficacy and antiretroviral therapy adherence among HIV positive pregnant women in South-West Nigeria: a mixed methods study

2018 ◽  
Vol 20 (4) ◽  
Author(s):  
Oluwabusayo H. Aregbesola ◽  
Ikeola A. Adeoye
Keyword(s):  
Pregnant Women ◽  
Treatment Adherence ◽  
Self Efficacy ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Art Adherence ◽  
Child Transmission ◽  
Mother To Child ◽  
In Pregnancy

Background: In Nigeria, an estimated 60,000 paediatric HIV infections occur annually mainly through mother-to-child transmission.  Adherence to antiretroviral therapy (ART) in pregnancy is crucial in preventing new paediatric HIV infections. We investigated HIV-treatment adherence self-efficacy and ART adherence among HIV-positive pregnant women in South-West Nigeria.Methods: A mixed method approach was employed using a sequential explanatory strategy in which HIV-positive pregnant women were recruited from three facilities providing Prevention of Mother-to-Child Transmission (PMTCT) services. Self-efficacy and adherence were assessed using the HIV-Treatment Adherence Self-efficacy Scale and the Centre for Adherence Support Evaluation Index Tool, respectively. A focus group discussion and key informant interviews were used to explore barriers and motivating factors to ART adherence in pregnancy. Quantitative data were analysed using descriptive statistics and logistic regression at 5% significance level, while thematic content analysis was used to analyse qualitative data. Results: A total of 126 women participated in the study. The mean age and mean gestational age of respondents were 32.7 ± 4.58 years and 24.4 ± 7.41 weeks, respectively. The prevalence of good adherence and HIV-treatment adherence self-efficacy were 70.6% and 26.2%, respectively. Low self-efficacy (OR=0.2, 95%CI=0.05– 0.53, p<0.05) was statistically associated with poor adherence. Planned pregnancy (OR=3.1, 95%CI=1.23-7.72, P<0.05) increased the likelihood for ART adherence. Looking healthier and protecting unborn babies were motivators to adherence while stigmatization and negative spousal influences were barriers to adherence.Conclusion: Low HIV-treatment adherence self-efficacy was related to poor adherence in pregnancy. Interventions aimed at improving adherence in pregnancy should also focus on HIV-treatment adherence self-efficacy.

Pregnancy syphilis epidemic trends, clinical features, APOs risk factors, pregnancy-induced hypertension epidemics and related factors, in Northeast China Jilin Maternity Hospital 2013-2017

2019 ◽  
Author(s):  
Fangfang Hu ◽  
Huixin Yang ◽  
Lixin Sun ◽  
Jingjing Luo ◽  
Siwen Zhang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternity Hospital ◽  
Age Group ◽  
Pregnancy Induced Hypertension ◽  
Child Transmission ◽  
Related Factors ◽  
Induced Hypertension ◽  
Maternal Syphilis ◽  
Mother To Child ◽  
In Pregnancy

Abstract Background. It is of great public health significance to monitor the global meiosis mother-to-child transmission plan proposed by WHO and monitor the prevalence of maternal syphilis and the factors affecting mother-to-child transmission. Methods. We collected 271 medical records of prenatally diagnosed (from 87286 pregnant women) of syphilis among pregnant women a maternity hospital in Jilin Province China from 2013 to 2017. The chi-square test and Logistic multiple regression analysis were used to describe the clinical characteristics of pregnant women with syphilis and the related factors of adverse pregnancy outcome. Results. The average prevalence of maternal syphilis is 0.31% (95%[CI]: 0.27%-0.35%). The mean age of 271 pregnant women with syphilis is 27.62±5.4 years old. The maternal syphilis prevalence of absence of paid occupation is 73.8%; rural population accounts for 43.6%. Maternal women with a history of abortion accounted for 43.1%, of which 53.1% had abortion ≥2; The average rate of treatment in pregnancy is 25.5% (95%[CI]: 25.4%-25.6%). The prevalence rate of APOs are 43.9% (95%[CI]: 38.1%-49.9%), declined in five years (P<0.05). APOs was significantly higher in women at 30–34 age group than that in 0-24 age group (OR= 2.916, 95%CI: 1.298-6.549) and higher in Un-treatment in pregnancy than that in receive treatment (OR=2.469, 95%CI:1.225-4.975). PROM occurrence (OR=2.702, 95%CI:1.219-5.988); CRP elevation (≥10 mg/L) and RPR high titer (≥1:8) are related to the occurrence of APOs. Abortion, prematurity and low birth weight are associated with no treatment during pregnancy (P<0.05). Comparison of 42 cases of pregnancy-induced hypertension and non-pregnancy-induced hypertension, Dysmenorrhea (OR= 3.654, 95%CI:1.812-7.369) and elevated urine protein (OR= 2.259, 95%CI:1.161-4.394) are the influencing factors of maternal syphilis complicated with pregnancy-induced hypertension. Conclusions. The prevalence of maternal syphilis in northern China is lower than that of 10 years ago, but the decline is still lower than that in the economically developed regions of the south. The rate of non-treatment of syphilis during pregnancy is high, and should be alert to the rebound of maternal syphilis.

scholarly journals Towards Elimination of Mother-to-Child Transmission of HIV: The Impact of a Rapid Results Initiative in Nyanza Province, Kenya

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Lisa L. Dillabaugh ◽  
Jayne Lewis Kulzer ◽  
Kevin Owuor ◽  
Valerie Ndege ◽  
Arbogast Oyanga ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Highly Active Antiretroviral Therapy ◽  
Cohort Analysis ◽  
Hiv Positive ◽  
Maternal Child Health ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Nyanza Province ◽  
The Impact ◽  
Mother To Child

Many HIV-positive pregnant women and infants are still not receiving optimal services, preventing the goal of eliminating mother-to-child transmission (MTCT) and improving maternal child health overall. A Rapid Results Initiative (RRI) approach was utilized to address key challenges in delivery of prevention of MTCT (PMTCT) services including highly active antiretroviral therapy (HAART) uptake for women and infants. The RRI was conducted between April and June 2011 at 119 health facilities in five districts in Nyanza Province, Kenya. Aggregated site-level data were compared at baseline before the RRI (Oct 2010–Jan 2011), during the RRI, and post-RRI (Jul–Sep 2011) using pre-post cohort analysis. HAART uptake amongst all HIV-positive pregnant women increased by 40% (RR 1.4, 95% CI 1.2–1.7) and continued to improve post-RRI (RR 1.6, 95% CI 1.4–1.8). HAART uptake in HIV-positive infants remained stable (RR 1.1, 95% CI 0.9–1.4) during the RRI and improved by 30% (RR 1.3, 95% CI 1.0–1.6) post-RRI. Significant improvement in PMTCT services can be achieved through introduction of an RRI, which appears to lead to sustained benefits for pregnant HIV-infected women and their infants.

scholarly journals Safety, strength and simplicity of efavirenz in pregnancy

2012 ◽  
Vol 13 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Prinitha Pillay ◽  
Vivian Black
Keyword(s):  
Pregnant Women ◽  
Health And Safety ◽  
Child Transmission ◽  
Child Health Outcomes ◽  
Hiv Epidemic ◽  
Resource Limited ◽  
Timing Of Initiation ◽  
Mother To Child ◽  
And Child Health ◽  
In Pregnancy

The WHO recommends starting lifelong ART for all pregnant women with a CD4 count at or below 350 cells/mm³, which recognises the important component of ‘when to start’ and the role that timing of initiation plays in reducing mortality and disease progression. The data on ‘what to start’ are conflicting, and options for resource-limited settings are limited. The choice of an ART regimen for pregnant women is complicated by the need to take into account the health and safety of both the mother and baby. Particularly contentious is whether to use a nevirapine- (NVP) or efavirenz- (EFV) based regimen. This review presents the latest evidence on the safety and efficacy of EFV and NVP in pregnancy and offers recommendations for improving maternal and child health outcomes and avoid mother-to-child transmission as South Africa moves toward turning back the tide on its HIV epidemic.

scholarly journals Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programs: the Mozambique experience

2020 ◽  
Author(s):  
Laurence Ahoua ◽  
Shino Arikawa ◽  
Thierry Tiendrebeogo ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Retention In Care ◽  
Retention Rates ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Appointment Adherence ◽  
Art Initiation ◽  
Mother To Child

Abstract Background : Failure to retain HIV-positive pregnant women on antiretroviral therapy (ART) leads to increased mortality for the mother and her child. This study evaluated different retention measures for women’s engagement along the continuum of care for prevention of mother-to-child transmission (PMTCT) option B+ services in Mozambique. Methods : We compared ‘point’ retention (patient’s presence in care 12-month post-ART initiation or any time thereafter) with the following definitions: alive and in care 12 month post-ART initiation (Ministry of Health; MOH); attendance at a health facility up to 15-month post-ART initiation (World Health Organization; WHO); alive and in treatment at 1-, 2-, 3-, 6-, 9-, and 12-month post-ART initiation (Inter-Agency Task Team; IATT); and alive and in care 12-month post-ART initiation with ≥75% appointment adherence during follow-up (i.e. ‘appointment adherence’ retention) or with ≥75% of appointments met on time during follow-up (i.e. ‘on-time adherence’ retention). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as our reference to estimate sensitivity, specificity, and proportion of misclassified patients. Results : Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12-month post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively). Conclusion : More stringent definitions indicated lower retention rates for PMTCT programs. Policy makers and program managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scale-up, and monitoring of interventions.

scholarly journals Measuring retention in care for HIV-positive pregnant women in Prevention of Mother-to-Child Transmission of HIV (PMTCT) option B+ programmes: the Mozambique experience

2019 ◽  
Author(s):  
Laurence Ahoua ◽  
Thierry Tiendrebeogo ◽  
Shino Arikawa ◽  
Maria Laheurta ◽  
Dario Aly ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Retention In Care ◽  
Retention Rates ◽  
Hiv Positive ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Appointment Adherence ◽  
Art Initiation ◽  
Mother To Child

Abstract Background Failure of retention of HIV-positive pregnant women on ART leads to increased mortality for the mother and her child. This study evaluated different retention measures intended to measure women’s engagement along the continuum of care for prevention of mother-to-child transmission (PMTCT) option B+ services in Mozambique. Methods We compared ‘point’ retention (patient’s presence in care at 12-months post-antiretroviral treatment (ART) initiation or any time thereafter) to the following definitions: alive and in care at 12 months post-ART initiation (Ministry of Health); attendance at a health facility up to 15 months post-ART initiation (World Health Organisation); alive and in treatment at 1, 2, 3, 6, 9, and 12 months post-ART initiation (Inter-Agency Task Team); and alive and in care at 12 months post-ART initiation with ≥75% appointment or on-time adherence during follow-up (‘appointment adherence’ and ‘on-time adherence’ retentions). Kaplan-Meier survival curves were produced to assess variability in retention rates. We used ‘on-time adherence’ retention as a gold standard to estimate sensitivity, specificity, and proportion of misclassified patients. Results Considering the ‘point’ retention definition, 16,840 HIV-positive pregnant women enrolled in option B+ PMTCT services were identified as ‘retained in care’ 12 months post-ART initiation. Of these, 60.3% (95% CI 59.6–61.1), 84.8% (95% CI 84.2–85.3), and 16.4% (95% CI 15.8–17.0) were classified as ‘retained in care’ using MOH, WHO, and IATT definitions, respectively, and 1.2% (95% CI 1.0–1.4) were classified as ‘retained in care’ using the ‘ ≥75% on-time adherence’ definition. All definitions provided specificity rates of ≥98%. The sensitivity rates were 3.0% with 78% of patients misclassified according to the WHO definition and 4.3% with 54% of patients misclassified according to the MOH definition. The ‘point’ retention definition misclassified 97.6% of patients. Using IATT and ‘appointment adherence’ retention definitions, sensitivity rates (9.0% and 11.7%, respectively) were also low; however, the proportion of misclassified patients was smaller (15.9% and 18.3%, respectively). Conclusion More stringent definitions indicated lower retention rates for PMTCT programmes. Policy makers and programme managers should include attendance at follow-up visits when measuring retention in care to better guide planning, scaling up, and monitoring of interventions.

scholarly journals Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016

2019 ◽  
Vol 18 ◽  
pp. 232595821983883 ◽  
Author(s):  
Dominic Ongaki ◽  
Mark Obonyo ◽  
Nancy Nyanga ◽  
James Ransom
Keyword(s):  
Pregnant Women ◽  
Referral Hospital ◽  
Hiv Positive ◽  
Urban Center ◽  
Child Transmission ◽  
Factors Affecting ◽  
Northern Kenya ◽  
Proxy Measure ◽  
Medical Identification ◽  
Mother To Child

Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother’s unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake of PMTCT.

scholarly journals HIV Retesting of HIV-Negative Pregnant Women in the Context of Prevention of Mother-to-Child Transmission of HIV in Primary Health Centers in Rural Zambia: What Did We Learn?

2019 ◽  
Vol 18 ◽  
pp. 232595821882353 ◽  
Author(s):  
Justin Mandala ◽  
Prisca Kasonde ◽  
Titilope Badru ◽  
Rebecca Dirks ◽  
Kwasi Torpey
Keyword(s):  
Pregnant Women ◽  
Hiv Positive ◽  
Antenatal Visit ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Loss To Follow Up ◽  
Hiv Test ◽  
Hiv Exposed ◽  
Mother To Child ◽  
Hiv Negative

Background: This observational study describes implementation of HIV retesting of HIV-negative women in prevention of mother-to-child transmission (PMTCT) services in Zambia. Methods: Uptake of retesting and PMTCT services were compared across age, parity, and weeks of gestation at the time of the first HIV test, antiretrovirals regime, and HIV early diagnosis results from infants born to HIV-positive mothers. Results: A total of 19 090 pregnant women were tested for HIV at their first antenatal visit, 16 838 tested HIV-negative and were offered retesting 3 months later: 11 339 (67.3%) were retested; of those, 55 (0.5%) were HIV positive. Uptake of the PMTCT package by women HIV positive at retest was not different but HIV-exposed infants born to women who retested HIV positive were infected at a higher rate (11.1%) compared to those born to women who tested HIV positive at their initial test (3.2%). Conclusion: We suggest rigorously (1) measuring the proportion of MTCT attributable to women who seroconvert during pregnancy and possibly adjust PMTCT approaches and (2) addressing the substantial loss to follow-up of HIV-negative pregnant women before HIV retesting.

Perceptions and Experiences of Participating in PMTCT Option B Plus: An Explorative Study on HIV-positive Pregnant Women in Eswatini

2021 ◽  
Vol 14 (1) ◽  
pp. 425-434
Author(s):  
Nompilo Dlamini ◽  
Busisiwe Ntuli ◽  
Sphiwe Madiba
Keyword(s):  
Pregnant Women ◽  
Hiv Positive ◽  
Test Results ◽  
Hiv Status ◽  
Child Transmission ◽  
Art Initiation ◽  
Purposeful Sampling ◽  
The Individual ◽  
Mother To Child ◽  
Roll Out

Background: Eswatini has adopted the PMTCT Option B+ approach as a strategy for the prevention of mother-to-child transmission of HIV. Objective: This study aimed to explore how pregnant Swazi women perceived and experienced PMTCT Option B+ and examined challenges they faced in disclosing their HIV status to their male partners. Methods: We interviewed 15 HIV-positive pregnant women selected using purposeful sampling from the PMTCT programme in Manzini Region, Eswatini. The data were analysed thematically. Results: The women had to deal with the pregnancy, the HIV-positive test results, the immediacy of the antiretroviral treatment (ART), and disclosure issues, all in one visit. They perceived the mandatory HIV testing and the same-day ART initiation as coercive. Regardless, they perceived PMTCT in a positive manner and as a gateway to early treatment for them. The drive to enroll in and remain in PMTCT was motivated by the belief in the efficacy of ART and the desire to protect their unborn babies from HIV infection. Their anticipation of rejection and violence from their partners led to their delaying disclosure and initiation of ART. Following disclosure, some of them were stigmatised, blamed for the infection, and abandoned by their partners. Conclusion: As Eswatini continues to roll out Option B+, there is a need to consider providing individualised counselling sessions to meet the individual needs of women.

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