What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.

<h4>Background</h4>High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda.<h4>Methods<...

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Autores principales:	Aggrey David Mukose, Hilde Bastiaens, Fredrick Makumbi, Esther Buregyeya, Rose Naigino, Joshua Musinguzi, Jean-Pierre Van Geertruyden, Rhoda K Wanyenze
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a23c504184044666b7e80f3675577677
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spelling	oai:doaj.org-article:a23c504184044666b7e80f36755776772021-11-25T05:54:19ZWhat influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.1932-620310.1371/journal.pone.0251181https://doaj.org/article/a23c504184044666b7e80f36755776772021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251181https://doaj.org/toc/1932-6203<h4>Background</h4>High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda.<h4>Methods</h4>A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data.<h4>Results</h4>Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women's personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15-8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04-1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery.<h4>Conclusions</h4>Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women's readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.Aggrey David MukoseHilde BastiaensFredrick MakumbiEsther BuregyeyaRose NaiginoJoshua MusinguziJean-Pierre Van GeertruydenRhoda K WanyenzePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251181 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Aggrey David Mukose Hilde Bastiaens Fredrick Makumbi Esther Buregyeya Rose Naigino Joshua Musinguzi Jean-Pierre Van Geertruyden Rhoda K Wanyenze What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.
description	<h4>Background</h4>High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda.<h4>Methods</h4>A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data.<h4>Results</h4>Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women's personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15-8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04-1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery.<h4>Conclusions</h4>Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women's readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.
format	article
author	Aggrey David Mukose Hilde Bastiaens Fredrick Makumbi Esther Buregyeya Rose Naigino Joshua Musinguzi Jean-Pierre Van Geertruyden Rhoda K Wanyenze
author_facet	Aggrey David Mukose Hilde Bastiaens Fredrick Makumbi Esther Buregyeya Rose Naigino Joshua Musinguzi Jean-Pierre Van Geertruyden Rhoda K Wanyenze
author_sort	Aggrey David Mukose
title	What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.
title_short	What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.
title_full	What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.
title_fullStr	What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.
title_full_unstemmed	What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.
title_sort	what influences uptake and early adherence to option b+ (lifelong antiretroviral therapy among hiv positive pregnant and breastfeeding women) in central uganda? a mixed methods study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a23c504184044666b7e80f3675577677
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What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.

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