Challenges of Antiretroviral Therapy Adherence Among Sero-positive Pregnant Women in Murang’a County Referral Hospital in Kenya

Abstract

Background: Adherence of or more than 95% to Antiretroviral Therapy (ART) has been highly regarded as a success in HIV treatment. Globally, there are various challenges associated with ART adherence among sero-positive pregnant women especially in sub-Saharan Africa. In Kenya, there is inadequate information on challenges of ART adherence among sero-positive pregnant women. Objective: To establish the challenges that influence ART adherence among sero-positive pregnant women in Murang’a county referral Hospital’s MCH Methodology: The research design was analytical cross-sectional design with a retrospective review of ANC records. The research study utilized both quantitative and qualitative methods of data collection using interviewer administered questionnaire for the sero-positive pregnant women and in-depth interview for the key informants. The sample size was 57 sero-positive pregnant women who were sampled using census method. Quantitative data cleaning and entry was done manually into MS-Excel spreadsheet and analysis done using Statistical Package for Social Sciences (SPSS) Program. Significance level of 95% was used to determine the strength of the association between variables. Qualitative data was analyzed using NVIVO 8 software. Results: Viral load results and pill counts results revealed that sero-positive pregnant women adhered to ART regimen until the viral load dropped to less than 50 copies of HIV. Challenges of ART adherence among sero-positive pregnant women were as follows: The literacy levels’ influence on ART adherence among the sero-positive pregnant women was significant in the following aspects; low education level (p=0.01), poor knowledge on condom use (p=0.004), selective disclosure (p=0.003), poor compliance to ART prescription (p=0.002)

and clients having a sense of full recovery (p=0.009). Cultural related factors that posed as challenges to ART adherence included; faith healing (p=0.037) and stigma (p= 0.0010). Hospital related factors included; under-staffing (p=0.001), drug side effects (p= 0.031), lack of enough space in the hospital (p=0.001) and unclear instructions to patients (p=0.009). The patient related factors found to influence ART adherence were: alcoholism (AOR=5; CI=3.8-7.0; p=0.004), forgetfulness AOR=5; CI=5.0-5.1; p=0.002), lack of family support (AOR=3; CI=3.0-5.1; p=0.037) and depression (AOR=2; CI=1.9-4.1; p=0.018). Conclusion: There exists other clients’ related challenges that affect ART adherence in addition to literacy related challenges, cultural related challenges and hospital related challenges. Recommendations: There is need to strengthen the health education given to sero-positive pregnant women to optimize the adherence level, destigmatize the patient status as well as the medication they are on.