Factors influencing adherene to nevirapine and AZT among HIV positive perinatal women at Pumwani maternity hospital in Nairobi, Kenya
Imbaya, Christopher Lumuli
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Twenty thousand children in Kenya are infected with HIV by their mothers annually mostly during the delivery period. Half of them die by the age of two years causing infant mortality to increase by 30%. Prevention of Mother to Child Transmission (PMTCT) of HIV is partly achieved through prophylactic treatment of the mothers with Antiretroviral (ARV) drugs during pregnancy. This was a cross-sectional study whose broad objective was to investigate the influence of socioeconomic factors on the adherence to two ARV's used for PMTCT namely Nevirapine (NVP) and Zidovudine (AZT). Specific objectives of the study were to determine the effect of the level of education, illness, forgetfulness, Antenatal Clinic (ANC) attendance, absence of drugs, health facility type, occupation, loss of medicine, religion, husband consent, counselling and testing, cultural beliefs and monthly expenditure on the adherence to NVP and AZT. The study further evaluated the factors promoting non-adherence to AZT and NVP and causes of single drug rather than dual treatment. Pre-tested questionnaires were used to collect data from 326 HIV+ women using the convenience sampling method. Descriptive statistics were used to summarize and analyze the data using the Statistical Package for Social Sciences (SPSS). Chi square was used to test the hypothesis which was accepted at p values <0.05.The participants ages ranged between 15 and 42 years, 72.9% were married and 15% single, 58.9% had primary school education, few no education and none university education. House wives were 38.3% while 31% of participants were involved in businesses and others either employed or at home. Monthly household expenditure ranged from 1,000 to 35,000 with an average of 8,000 shillings Adherence to the two drugs was significantly associated with level of education (p=0.0117) and economic status (p=0.0109). Frequency of ANC attendance was significantly associated with number of ARV's dispensed (p=0.001) but not to the adherence (p=0.62186). No significant relationship was established between adherence and husband's consent, religion, loss of medicine, occupation, age and marital status. Non-adherence occurred mainly due to forgetfulness. More than half (53.5%) of the women received single ARV therapy which was mostly NVP rather than AZT. Reasons for taking NVP as a single drug were maternal illness and late clinic attendance while lack of medicine resulted in single use of AZT. Fear of knowing their HIV status led some women not to be tested for HIV after counselling while lack of test kits resulted in others not being tested. We recommend that women need to be motivated to attend ANC early and frequently so as to receive full ARV treatment. Directly observed treatment and reminder options should be explored by Ministry of Health (MOH) to minimize forgetfulness. Women who for various reasons fail to receive NVP or AZT should be provided with alternative ARV's. Logistic and supply chains procedures need to be streamlined to ensure constant drug availability. Further evaluation of the influence of economic status and level of education on ARV adherence needs to be researched by also involving rural and private sector patients.