Determinants of adherence to ARVs in HIV+ women enrolled in the PMTCT program in the West and North Regions of Cameroon
Background: According to UNAIDS 2019, 52% of people worldwide living with HIV is on antiretrovirals (ARVs), HIV positive women representing 80% of them. This study aimed at highlighting the determinants of adherence to ARVs for HIV positive women enrolled in PMTCT programs in the West and North Regions of Cameroon.
Methods: A descriptive and analytical cross-sectional study was carried out from February to September 2019 in three treatment centres in the West (Bafoussam Regional Hospital and Dschang District Hospital) and North (Garoua Regional Hospital) regions in Cameroon. Data were collected using a questionnaire administered face to face and encoded in Excel 2013, then analyzed using SAS version 7.8. P-values < 0.05 were considered statistically significant
Results: One thousand (1000) women were interviewed. The mean age was 17 ±2 years (Range: 12 – 67 years); 231 (23.1%) were single. Overall, the prevalence of ART-adherence was 68.6%. After multivariate analysis using multiple logistic regression; having one HIV-infected children (aOR=60.9; 95%CI=[7.6; 489.1]; P=0.001), non-disclosure of serological status with the spouse/boyfriend (aOR=25.2; 95%CI=[9.2; 68.9]; P<0.001), not being educated (aOR=7.7; 95%CI=[4.4; 13.3]; P<0.001); and taking ARVs once or less daily (aOR=50; 95%CI=[20.0; 100.0]; P<0.001) were four risk factors for non-adherence.
Conclusion: ART-adherence among Cameroonian pregnant women is still very far below UNAIDS target (95%), with four potential key determinants identified. As we are progressively moving towards the elimination of HIV vertical transmission in 2030 as advocated by UNAIDS, local policies should be reinforced in order to consolidate the strides made so far.
Keywords: HIV, PMTCT, Pregnancy, Adherence, option B+, Cameroon.
2. Omonaiye O, Kusljic S, Nicholson P, Manias E. Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: A systematic review. BMC Public Health. 2018; 18(1):1–20.
3. Tarekegn M. Adherence to option b+ and associated factors among pregnant women on pmtct services at public health facilities of east shawa zone, oromia, ethiopia. 2017; 1–7.
4. Onusida. Statistiques mondiales sur le Vih en 2019 [Internet]. 2019 [cited 2019 Oct 22]. p. 1. Available from: https://www.unaids.org/fr/regionscountries/countries/cameroon
5. Sarkar S, Corso P, Ebrahim-Zadeh S, Kim P, Charania S, Wall K. Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review. EClinicalMedicine [Internet]. 2019; 10:10–31. Available from: https://doi.org/10.1016/j.eclinm.2019.04.006
6. Adetokunboh OO, Oluwasanu M. Eliminating mother-to-child transmission of the human immunodeficiency virus in sub-Saharan Africa: The journey so far and what remains to be done. J Infect Public Health [Internet]. 2016; 9(4):396–407. Available from: http://dx.doi.org/10.1016/j.jiph.2015.06.010
7. PEPFAR. CAMEROON Country Operational Plan COP 2020 Strategic Direction Summary. 2020;
8. Auvinen J, Kylmä J, Välimäki M, Bweupe M, Suominen T. Barriers and Resources to PMTCT of HIV: Luba-Kasai Men’s Perspective in Lusaka, Zambia. J Assoc Nurses AIDS Care. 2013; 24(6):554–68.
9. Yah CS, Tambo E. Why is mother to child transmission (MTCT) of HIV a continual threat to new-borns in sub-Saharan Africa (SSA). J Infect Public Health [Internet]. 2019; 12(2):213–23. Available from: https://doi.org/10.1016/j.jiph.2018.10.008
10. Msellati P. Improving mothers’ access to PMTCT programs in West Africa: A public health perspective. Soc Sci Med [Internet]. 2009; 69(6):807–12. Available from: http://dx.doi.org/10.1016/j.socscimed.2009.05.034
11. Tebeu PM, Vifeme MM, Nshom EM. Determinants of non- adherence to antiretroviral therapy among Option B + cases in Ndop and Fundong health districts , Northwest Region , Cameroon. 2019; (October 2018):112–4.
12. Pefura-yone EW, Soh E, Pascal A, Dodo A, Kuaban C. Non-adherence to antiretroviral therapy in Yaounde : Prevalence , determinants and the concordance of two screening criteria. J Infect Public Health [Internet]. 2013; 6(4):307–15. Available from: http://dx.doi.org/10.1016/j.jiph.2013.02.003
13. Atanga PN, Ndetan HT, Fon PN, Meriki HD, Muffih TP, Achidi EA. Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B +. 2018; 9:1–10.
14. Ebuy H, Yebyo H, Alemayehu M. International Journal of Infectious Diseases Level of adherence and predictors of adherence to the Option B + PMTCT programme in Tigray , northern Ethiopia. Int J Infect Dis [Internet]. 2015; 33:123–9. Available from: http://dx.doi.org/10.1016/j.ijid.2014.12.026
15. Omonaiye O, Kusljic S, Nicholson P, Mohebbi M, Manias E. International Journal of Infectious Diseases Post Option B + implementation programme in Nigeria : Determinants of adherence of antiretroviral therapy among pregnant women with HIV. Int J Infect Dis [Internet]. 2019; 81:225–30. Available from: https://doi.org/10.1016/j.ijid.2019.02.014
16. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol from Bed to Bench. 2013; 6(1):14–7.
17. Zacharius KM, Basinda N, Marwa K, Mtui EH, Kalolo A, Kapesa A. Low adherence to Option B + antiretroviral therapy among pregnant women and lactating mothers in eastern Tanzania. PLoS One. 2019; 14(2):1–12.
18. Tesfaye DJ, Hibistu DT, Abebo TA, Asfaw FT, Lukas K, Laelago T, et al. Option B plus antiretroviral therapy adherence and associated factors among HIV positive pregnant women in Southern Ethiopia. BMC Pregnancy Childbirth. 2019; 19(1):1–8.
19. Ayuo P, Musick B, Liu H, Braitstein P, Nyandiko W, Otieno-Nyunya B, et al. Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya. J Int AIDS Soc. 2013; 16.
20. Okawa S, Chirwa M, Ishikawa N, Kapyata H, Msiska CY, Syakantu G, et al. Longitudinal adherence to antiretroviral drugs for preventing mother-to-child transmission of HIV in Zambia. BMC Pregnancy Childbirth [Internet]. 2015; 1–10. Available from: http://dx.doi.org/10.1186/s12884-015-0697-7
21. Schnack A, Rempis E, Decker S. Prevention of Mother-to-Child Transmission of HIV in Option B + Era : Uptake and Adherence During Pregnancy. 2016; 30(3):110–8.
22. WHO. HIV Status Disclosure to Sexual Partners: Rates, Barriers and Outcomes for Women [Internet]. World Health Organization; 2004. Available from: http://www.who.int/genderequity-rights/knowledge/9241590734/en/
23. Colombini M, Stöckl H, Watts C, Zimmerman C, Agamasu E, Mayhew SH. Factors affecting adherence to short-course ARV prophylaxis for preventing mother-to-child transmission of HIV in sub-Saharan Africa: A review and lessons for future elimination. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2014; 26(7):914–26.
24. Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: A systematic review. J Int AIDS Soc. 2013; 16:1–21.
25. Hodgson I, Plummer ML, Konopka SN, Colvin CJ, Jonas E, Albertini J, et al. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS One. 2014; 9(11).
26. Kuonza LR, Tshuma CD, Shambira GN, Tshimanga M. Non-adherence to the single dose nevirapine regimen for the prevention of mother-to-child transmission of HIV in Bindura town, Zimbabwe: A cross-sectional analytic study. BMC Public Health. 2010;10:1–8.
27. Joseph A, Ogah OE, Robinson O, Matthew NI. Determinants of Adherence to Antiretroviral Therapy among HIV-Positive Women Accessing Prevention of Mother to Child Transmission Services in Ebonyi State , Nigeria. 2018; 248–53.
28. Murithi LK, Masho SW, Vanderbilt AA. Factors Enhancing Utilization of and Adherence to Prevention of Mother-to-Child Transmission (PMTCT) Service in an Urban Setting in Kenya. AIDS Behav. 2015; 19(4):645–54.
29. Buregyeya E, Naigino R, Mukose A, Makumbi F, Esiru G, Arinaitwe J, et al. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: A qualitative study. BMC Pregnancy Childbirth. 2017; 17(1):1–9.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).