Determinants of non-adherence to antiretroviral therapy among seropositive pregnant women at public health facilities in Dessie Town, Ethiopia, 2024.

Abstract

Background: Non-adherence to antiretroviral therapy (ART) among pregnant women poses significant challenges to effective Immunodeficiency Virus (HIV) treatment outcomes and the promotion of maternal and infant health. This study identifies factors influencing ART non-adherence among HIV-positive pregnant women attending public health facilities in Dessie Town, Ethiopia.

Methods: A facility-based case-control study was conducted with 278 participants across health institutions in Dessie Town, comprising 208 controls and 70 cases. Non-adherence to ART was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8. Data were collected through structured interviewer-administered questionnaires and by reviewing patients' medical records using pretested instruments. The collected data were coded and entered into EpiData version 4.6, then analyzed using SPSS version 25. Variables with a P-value of 0.2 in Bivariable analysis were included in a multivariable regression model, and Adjusted Odds Ratios (AOR) with 95% confidence intervals (CI) were calculated. P-values less than 0.05 were considered statistically significant.

Results: In total, 208 controls and 70 cases were included in the study. Significant factors determining non-adherence to ART among HIV-positive pregnant women included forgetfulness to take ART (AOR = 2.414, 95% CI = 1.067-5.464, P = 0.034), non-disclosure (AOR = 2.955, 95% CI = 1.431-6.103, P = 0.003), an unplanned pregnancy (AOR = 3.045, 95% CI = 1.439-6.445, P = 0.004), those who did not participate in mother-support groups (AOR = 3.278, 95% CI = 1.611-6.672, P = 0.001), World Health Organization (WHO) clinical stages III & IV (AOR = 2.669, 95% CI = 1.279-5.569, P = 0.009), and those who did not take opportunistic infection prophylaxis (AOR = 3.873, 95% CI = 1.549-9.688, P = 0.004).

Conclusions: Key determinants included forgetfulness, non-disclosure of HIV status, unplanned pregnancies, lack of participation in mother-support groups, advanced WHO clinical stages (III & IV), and non-use of opportunistic infection prophylaxis.

Recommendations: All relevant parties, including front-line healthcare professionals, should advise women to use family planning more frequently to reduce unintended pregnancies. They should also encourage health education regarding disclosing HIV status to her spouse and ensure that all pregnant women are provided with opportunistic infection prophylaxis.