Impact of Socio-demographic and Psychosocial Factors on Adherence to Antiretroviral Thepary Among Mothers Attending Antenatal Clinics at Mbagathi and Kenyatta National Hospitals

Abstract

Background: Studies have indicated that adherence to antiretroviral therapy is associated with improved treatment outcome. In expectant mothers, it also ensures reduced viral load prior to delivery and during breastfeeding, both of which reduce chances of vertical transmission. Conversely, reduced adherence is associated with development of resistance to the antiretroviral therapy and poor clinical outcomes. Adherence level is affected by various psychosocial factors such as anxiety, depression and social support. There are limited published studies to find out the impact of psychosocial factors on the level of adherence among the pregnant HIV infected women in Kenya. Objectives: The main objective of this study was to determine the impact of socio-demographic and psychosocial factors on adherence to antiretroviral therapy among mothers attending antenatal clinics at Mbagathi and Kenyatta National Hospitals. Methodology: This was a cross-sectional descriptive study carried out at the antenatal clinics of Kenyatta National Hospital and Mbagathi County Hospital from 1st April to 30th July 2023. The study population comprised of 70 HIV infected antenatal clinic mothers who were on antiretroviral therapy. Participants who met the inclusion criteria and who gave written informed voluntary consent were enrolled into the study. A pre-tested standardized questionnaire was used to collect information on the socio-demographics, anxiety, depression, and perceived social support. Adherence to antiretroviral therapy was determined using the 8- scale Morisky tool. Data management: Data analysis was done using IBM SPSS Chicago Illinois version 23. Prevalence and severity of anxiety, depression and perceived social support were computed and presented as percentages. Association between adherence and various psychosocial factors were determined by use of chi square or Fischer’s exact test. Binary logistic regression analysis was carried out to determine the independent correlates of adherence to antiretroviral therapy. Variables with P value<=0.05 were interpreted as statistically significant. Results: The mean age of the study population was 32.3 (SD 5.78) and majority were aged between 18 – 35 years (67.1%), had attained at least a secondary school education level (47.1%) and married (75.7%). The prevalence of adherence to antiretroviral therapy was 78.8% among the HIV infected mothers, with low adherence (47.1%), moderate adherence (21.4%) and high adherence at 31.4%. Prevalence of anxiety was 23.8%, depression (22.6%) and social support (45.7%). There was no statistically significant association between adherence and any of the psychosocial factors under study. However, there was a statistically significant association between level of education and adherence (aOR= 0.257, 95%CI: 0.068 – 0.982, P=0.047) with participants who attained college education level having higher odds of adherence compared to their counterparts in secondary level and below. Conclusion: Adherence to antiretroviral therapy was sub-optimal and there was considerable level of comorbid psychosocial burden with anxiety, depression, and social support. Higher level of education was significantly associated with good adherence suggesting that adherence mechanisms should be intensified for mothers who have not attained tertiary education level. Integration of psychological and psychiatric services in the Prevention of Mother to Child Transmission Program is recommended. Further studies to underscore other potential barriers to antiretroviral therapy adherence such as side effects of antiretroviral medicine and socio-economic factors is recommendable.