Level of Adherence to Option B+ Antiretroviral Therapy Among HIV Positive Pregnant Women Attending Antenatal Clinics at Tertiary Health Institutions in Anambra State, Nigeria
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This study assessed adherence to option B+ antiretroviral therapy among HIV-positive pregnant women in Anambra State, Nigeria, revealing that 89% of participants were adherent while 11% were not. The main reasons for non-adherence included forgetfulness and being away from home. The findings highlight a good level of adherence but indicate a need for improved educational efforts to achieve 100% adherence to prevent mother-to-child transmission of HIV.
![Contents lists available at BioMedSciDirect Publications
International Journal of Biological & Medical Research
Journal homepage: www.biomedscidirect.com
Int J Biol Med Res. 2025; 16(1): 7952-7955
Case Report
Level of Adherence to Option B+ Antiretroviral Therapy Among HIV Positive Pregnant Women Attending Antenatal
Clinics at Tertiary Health Institutions in Anambra State, Nigeria
Silas Esther A1
, Clementina U. Nwankwo1
, Chika Chioma H. Odira1
, ObionwuOgochukwuT2
1
Department of Nursing Science, Faculty of Health Sciences & Technology, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria.
2
Medical Centre, college of Health sciences, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria.
A R T I C L E I N F O A B S T R A C T
Keywords:
Adherence,
HIV,
Positive,
Pregnant,
Women.
Aim: This study ascertained level of adherence to option B+ antiretroviral therapy (B+ ART) among HIV
positive pregnant women attending antenatal clinics at tertiary health institutions in Anambra state and
reason(s) for non-adherence. Materials and methods: A cross-sectional descriptive design was adopted in
conducting the study among HIV positive pregnant women attending antenatal clinics at tertiary health
institutions in Anambra state. Purposive and convenience sampling techniques were used to select sample
size of one hundred and forty-six (146) HIV positive pregnant women by Adult AIDS Clinical Trial Group
(AACTG) standardized questionnaire was used in data collectionwhich were analysed with IBM SPSS software
database (version 25). Results: Results revealed that 89% of the HIV positive pregnant women adhered to
Option B+ ART while 11% of the women were not adherent to their antiretroviral drugs. Conclusion: From
the study, the level of adherence to Option B+ ART among HIV positive pregnant women attending the tertiary
health institutions in Anambra state is good but there is still need for improvement to reach the peak which
is 100% adherence so as to totally eliminate mother to child transmission of HIV. Recommendations: Nurses
and mentor mothers in the health care facilities should intensify health education on adherence to ART.
© Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685.
Introduction
HIV is a deadly virus that attacks and weakens the immune system of
human beings making the affected individual susceptible to infection.
Since the beginning of the epidemic, 85.6 million people have been
infected with the HIV virus and about 40.4 million people have died
of HIV [1].Globally, 39.0 million people were living with HIV at the end
of 2022 and an estimated 0.7% of adults aged 15–49 years worldwide
are living with HIV, although the burden of the epidemic continues to
vary considerably between countries and regions [1]. The WHO African
Region remains most severely affected, with nearly 1 in every 25 adults
(3.2%) living with HIV and accounting for more than two-thirds of
the people living with HIV worldwide [1]. In Nigeria, approximately 2
million adults aged 15-49 years of age are living with HIV [2] and of the
estimated 220,000 new infections in Nigeria, 37,000 were from mother-
to-child transmission [3].
Corresponding author:
Silas Esther A
Department of Nursing Science,
Faculty of Health Sciences & Technology,
NnamdiAzikiwe University,
Nnewi Campus, Anambra State, Nigeria.
Email: ea.silas@unizik.edu.ng
© Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685.
To address the International Human Immunodeficiency Virus epidemic,
the World Health Organization developed three drug treatment
regimens between 2010 and 2012 specifically for HIV positive pregnant
women and their infants. World Health Organization (WHO) developed
the regimens calling them Option A, Option B and Option B+, to reduce
or prevent mother to child transmission of HIV. Each option comprises
of different types and schedules of antiretroviral medications [4].
WithOption B+ all HIV-infected pregnant and breastfeeding women are
immediately initiatedon lifelong antiretroviral therapy (ART), regardless
of clinical stage or CD4+ T-cell count unlike what is obtainable in Option
A and B. Option B+ which is an improved version of both option A and
option B treatment regimen was introduced in 2012 but was adopted in
Nigeria in 2016 with full implementation reported in 2017 [5].
Non adherence to Antiretroviral Therapy(Option B+) by HIV positive
pregnant women will increase their chances of transmitting HIV to
their babies either during pregnancy, labour or delivery and if HIV is
transmitted to the baby, it will weaken the baby’s immune system
resulting to increased susceptibility to infection and failure to thrive
afterwards [6].
A descriptive cross-sectional survey done by Oginni, Aremu,
Olowokere, Ayamolowo and Komolafe [7]on HIV positive pregnant
women in Ibadan, Nigeria revealed poor level of adherence as only 47%
of the women adhered to their drug regimen. Also, Omonaiyeet al.[5] in
their study on adherence to ART in AkwaIbom State in the South- South
region of Nigeria also recorded poor adherence (32.7%).
The researcher discovered that the studies on adherence to ART
done in Nigeria showed poor adherence (as shown above) while those
conducted outside Nigeria revealed good adherence therefore this study
was borne out of curiosity to determine level of adherence to Option B+
ART among HIV positive pregnant women attending antenatal clinics at](https://image.slidesharecdn.com/levelofadherencetooptionbantiretroviraltherapyamonghivpositivepregnantwomenattendingantenatal-250111084921-8a3cc954/85/Level-of-Adherence-to-Option-B-Antiretroviral-Therapy-Among-HIV-Positive-Pregnant-Women-Attending-Antenatal-Clinics-at-Tertiary-Health-Institutions-in-Anambra-State-Nigeria-1-320.jpg)
![Silas Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955
7954
Table 1.1 showed that majority of the women 101(67.8%) were in the
age range of 26-35 years, followed by 41(27.5%) within the age range
of 15-25 years then 6(4.0%) in the age range of 36-45 years and finally
1(0.7%) in the age range of 46-55 years. Also, majority of the women
145(97.3%) were Christians, 1(0.7%) was a traditionalist, 1(0.7%) of
the respondents was a muslim and 2(1.3%) fell under ‘others’ (atheists).
Majority of the respondents were married (148(99.3%) and 1(0.7%)
was divorced. 73(49.0%) of the women were into business, 44(29.5%)
were professionals while 32(21.5%) are unemployed. 144(96.6%) of
the women were Ibos, 2(1.3%) followed by those from other ethnic
groups (2(1.3%) while 1(0.7%) of the respondents were Hausas.
99(66.4%) of the women had tertiary education, 45(30.2%) stopped
at secondary school while 5(3.4%) of the respondents had no formal
education. 72(48.3%) of the respondents had a child less than five years,
43(28.9%) had two children less than five years, 21(14.1%) had three
children below five years while 13(8.7%) had four children less than
five years of age.
Research Question 1: What is the level of adherence of the HIV
positive pregnant women to option B+ ART?
Table 1.2: The self-reported Adherence of the HIV Positive Pregnant
Women to Option B+ ART n=146
Adherence to option B+
ART
n (%) Percentage (%)
Adherent 130 89.0
Non-adherent 16 11.0
Total 146 100.0
Have you skipped taking pills before?
No 113 77.4
Yes 33 22.6
Total 146 100.0
When last did you skip a pill? n=33
Within last four days 10 30.3
Yesterday 3 9.1
Day before yesterday 3 9.1
Last weekend (Saturday
and/or Sunday)
4 12.1
Within last two weeks 12 36.4
Within last four weeks 1 3.0
Total 33 100.0
Table 1.2 shows that130(89%) HIV positive pregnant women that were
part of the study are adherent to Option B+ ART while 16(11%) of the
women are not. 33 (22.6%) have skipped their drugs before while
113(77.4%) have not skipped their drugs before. Out of the 33 that
have skipped their drugs before, 10 skipped it within the last four days,
3 skipped yesterday, 3 skipped a day before, 4 skipped last weekend, 12
skipped within last 2 weeks and only one skipped within last four weeks
as at the time the questionnaires were administered.
Table 1.3: Reasons for Missing ART Dose in the Past n=33
Reasons for missing ART dose in the
past
(multiple responses) n = 33
Yes (%) No (%)
Simply forgot 12(36.4) 21(63.6)
Away from home 11(33.3) 22(66.7)
Busy with other things 5(15.2) 28(84.8)
Had a change in daily routine 1(3.0) 32(97.0)
Fell asleep/slept through dose 2(6.0) 31(94.0)
Had problems taking drugs at specific
times
1(3.0) 32(97.0)
Felt ill or sick 4(12.1) 29(87.9)
Wanted to avoid side effects 3(9.0) 30(91.0)
Felt depressed/overwhelmed 1(3.0) 32(97.0)
Had too many pills to take 1(3.0) 32(97.0)
Did not want others to notice me taking
drugs
2(6.0) 31(94.0)
Felt drug was toxic 3(9.0) 30(91.0)
The above are the reasons for missing Option B+ ART by the sixteen
women that missed their medication in the last four days. Major reason by
the women was forgetfulness 12(36.4), followed by being away from home
11(33.3%), busyness 5(15.2), illness 1(12.1%), feeling that drug is toxic
3(9%), side effects 3(9%), change in daily routine 1(3%), issue taking
drugs 1(3%), depression 1(3%), too many pills to take 1(3%).
DISCUSSIONS
Research Question 1: What is the level of adherence of the HIV positive
pregnant women to option B+ ART?
It was discovered from the study that 130(89%) of the HIV positive
pregnant women adhered to option b+ ART while 16(11%) of the women
were not adherent to their drugs. A respondent is considered adherent if
shehasnot missedtaking anydosesovera 4-dayperiodpriordayofsurvey.
Missing at least one dose over the 4 days’ period prior day of survey is
considered as non-adherent. This entails that majority of the HIV positive
pregnant women that participated in this study showed good adherence
to Option B+ ART. This revealed that majority of the HIV positive pregnant
women that participated in this study showed good adherence to Option
B+ ART. This is likely due to the effort of the mentor mothers and nurses
in counselling the women on the need for adherence to their medications.
This finding is line with the findings of Ebuyet al. [8] In their study,
they determined the level of adherence to Option B+ PMTCT drugs and
factors associated with adherence among HIV positive pregnant women
in public hospitals of Northern Ethiopia. From their findings, 87.1% of
their respondents were adherent to Option B+ ART which they described
as reasonably good. Also, Mukoshaet al.[9] in their study in Lusaka
Zambia discovered that 81.7% of their respondents were adherent to
their medication (ART).However, the findings contrast that of Oginniet
al.[7] which showed that only 47% of the respondents adhered to their
drug regimen and that of Omonaiye, et al.[5] which pointed out that only
32.7% of the HIV positive women that took part in the study self-reported
to have taken all ART doses in the past 96 hours following the study.The
disparity in findings might be due to different level of efforts that was
made in counselling and creating awareness on the need for adherence by
the nurses and mentor mothers at different health facilities.](https://image.slidesharecdn.com/levelofadherencetooptionbantiretroviraltherapyamonghivpositivepregnantwomenattendingantenatal-250111084921-8a3cc954/85/Level-of-Adherence-to-Option-B-Antiretroviral-Therapy-Among-HIV-Positive-Pregnant-Women-Attending-Antenatal-Clinics-at-Tertiary-Health-Institutions-in-Anambra-State-Nigeria-3-320.jpg)
![Reasons for non-adherence of the HIV positive pregnant
16(11%) of the women were not adherent to their drugs. They indicated
the following as reasons: Forgetfulness, being away from home, busyness,
change in daily routine, sleepiness, illness, side effect of drugs, depression,
too many pills to take, hiding from others, feeling that drug is toxic, not
wanting to be noticed by others while taking drugs.
Forgetting to take their drugs and being away from home are both
unintentional revealing that the majority of the women do not miss taking
their drugs intentionally. Also being busy can make the women forget
to take their drugs. The finding above is in line with that of Tesfaye and
Melese [10] who determined adherence to antiretroviral therapy among
people living with HIV/AIDS in Hara town and its surroundings, North
Eastern Ethiopia. Their findings showed that participants who had never
encountereddrugsideeffectswere2.69timesmorelikelytoadheretotheir
ART medication than those who had ever encountered drug side effect. In
agreement, Wondimu, et. al.[11] in their study in Central Ethiopia, found
out that fear of stigma for taking ART was among the associated factors
enhancing the adherence to PMTCT Option B+ care.
Also Nthala, et al.[12] in their study discovered that adherence to ART
was a challenge (low) that needed to be addressed and reasons for that
included economic factors (lack of food), physical factors (side effects of
the drugs), environmental factors (long waiting hours with long queues)
and community factors (social stigma). Still in line with the above findings,
Obonyo [13] from her findings opined that fear of discrimination and
stigma (69.9%) also affected adherence to ART. Ebuyet al.[8]in their
cross-sectional study identified that among the challenges for adherence
to Option B+ PMTCT, forgetting to take the medications (92.3%) was the
dominant obstacle, followed by the fear of side effects (38.5%).
On the contrary, the study carried out by Chukwukaodinaka [14] in
FCT, Abuja, Nigeria, revealed that PMTCT services were hindered by the
following: permission from spouse before being tested, couple counselling
not done, group posttest counselling, non-incorporation of family
planning and low support group enrolment. The different reasons for non-
adherence to ART might likely be due to the options in the questionnaire. It
can also be due to different individuals that participated in and conducted
the studies.
Conclusion
The level of adherence to Option B+ ART among HIV positive pregnant
women attending the tertiary health institutions in Anambra state is good
but there is still need for improvement to reach the peak which is 100%
adherence so as to totally eliminate mother to child transmission of HIV.
Acknowledgements – No acknowledgements
Declaration of interest: The authors declare there is no conflict of
interest of any form with regards to this study
Funding sources: There was no external source of funding received for
this study from any funding institutions or donor with regards to this
study.
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las Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955
7955
© Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685.](https://image.slidesharecdn.com/levelofadherencetooptionbantiretroviraltherapyamonghivpositivepregnantwomenattendingantenatal-250111084921-8a3cc954/85/Level-of-Adherence-to-Option-B-Antiretroviral-Therapy-Among-HIV-Positive-Pregnant-Women-Attending-Antenatal-Clinics-at-Tertiary-Health-Institutions-in-Anambra-State-Nigeria-4-320.jpg)
Level of Adherence to Option B+ Antiretroviral Therapy Among HIV Positive Pregnant Women Attending Antenatal Clinics at Tertiary Health Institutions in Anambra State, Nigeria
- 1. Contents lists available at BioMedSciDirect Publications International Journal of Biological & Medical Research Journal homepage: www.biomedscidirect.com Int J Biol Med Res. 2025; 16(1): 7952-7955 Case Report Level of Adherence to Option B+ Antiretroviral Therapy Among HIV Positive Pregnant Women Attending Antenatal Clinics at Tertiary Health Institutions in Anambra State, Nigeria Silas Esther A1 , Clementina U. Nwankwo1 , Chika Chioma H. Odira1 , ObionwuOgochukwuT2 1 Department of Nursing Science, Faculty of Health Sciences & Technology, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria. 2 Medical Centre, college of Health sciences, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria. A R T I C L E I N F O A B S T R A C T Keywords: Adherence, HIV, Positive, Pregnant, Women. Aim: This study ascertained level of adherence to option B+ antiretroviral therapy (B+ ART) among HIV positive pregnant women attending antenatal clinics at tertiary health institutions in Anambra state and reason(s) for non-adherence. Materials and methods: A cross-sectional descriptive design was adopted in conducting the study among HIV positive pregnant women attending antenatal clinics at tertiary health institutions in Anambra state. Purposive and convenience sampling techniques were used to select sample size of one hundred and forty-six (146) HIV positive pregnant women by Adult AIDS Clinical Trial Group (AACTG) standardized questionnaire was used in data collectionwhich were analysed with IBM SPSS software database (version 25). Results: Results revealed that 89% of the HIV positive pregnant women adhered to Option B+ ART while 11% of the women were not adherent to their antiretroviral drugs. Conclusion: From the study, the level of adherence to Option B+ ART among HIV positive pregnant women attending the tertiary health institutions in Anambra state is good but there is still need for improvement to reach the peak which is 100% adherence so as to totally eliminate mother to child transmission of HIV. Recommendations: Nurses and mentor mothers in the health care facilities should intensify health education on adherence to ART. © Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685. Introduction HIV is a deadly virus that attacks and weakens the immune system of human beings making the affected individual susceptible to infection. Since the beginning of the epidemic, 85.6 million people have been infected with the HIV virus and about 40.4 million people have died of HIV [1].Globally, 39.0 million people were living with HIV at the end of 2022 and an estimated 0.7% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions [1]. The WHO African Region remains most severely affected, with nearly 1 in every 25 adults (3.2%) living with HIV and accounting for more than two-thirds of the people living with HIV worldwide [1]. In Nigeria, approximately 2 million adults aged 15-49 years of age are living with HIV [2] and of the estimated 220,000 new infections in Nigeria, 37,000 were from mother- to-child transmission [3]. Corresponding author: Silas Esther A Department of Nursing Science, Faculty of Health Sciences & Technology, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria. Email: ea.silas@unizik.edu.ng © Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685. To address the International Human Immunodeficiency Virus epidemic, the World Health Organization developed three drug treatment regimens between 2010 and 2012 specifically for HIV positive pregnant women and their infants. World Health Organization (WHO) developed the regimens calling them Option A, Option B and Option B+, to reduce or prevent mother to child transmission of HIV. Each option comprises of different types and schedules of antiretroviral medications [4]. WithOption B+ all HIV-infected pregnant and breastfeeding women are immediately initiatedon lifelong antiretroviral therapy (ART), regardless of clinical stage or CD4+ T-cell count unlike what is obtainable in Option A and B. Option B+ which is an improved version of both option A and option B treatment regimen was introduced in 2012 but was adopted in Nigeria in 2016 with full implementation reported in 2017 [5]. Non adherence to Antiretroviral Therapy(Option B+) by HIV positive pregnant women will increase their chances of transmitting HIV to their babies either during pregnancy, labour or delivery and if HIV is transmitted to the baby, it will weaken the baby’s immune system resulting to increased susceptibility to infection and failure to thrive afterwards [6]. A descriptive cross-sectional survey done by Oginni, Aremu, Olowokere, Ayamolowo and Komolafe [7]on HIV positive pregnant women in Ibadan, Nigeria revealed poor level of adherence as only 47% of the women adhered to their drug regimen. Also, Omonaiyeet al.[5] in their study on adherence to ART in AkwaIbom State in the South- South region of Nigeria also recorded poor adherence (32.7%). The researcher discovered that the studies on adherence to ART done in Nigeria showed poor adherence (as shown above) while those conducted outside Nigeria revealed good adherence therefore this study was borne out of curiosity to determine level of adherence to Option B+ ART among HIV positive pregnant women attending antenatal clinics at
- 2. Silas Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955 7953 TABLE 1.1: Summary of Socio-demographic Characteristics of the Women (n=146) Characteristics Frequency Percentage 1 Age 15 – 25 33 22.6 26 – 35 70 47.9 36 - 45 41 28.2 Above 45 2 1.4 2 Religion Christian 141 96.6 Islam 2 1.4 Traditional 3 2.1 3 Marital status Married 121 82.9 Divorced 4 2.7 Widowed 9 6.2 Single 12 8.2 4 Occupation Formal sector 34 23.2 Informal sector 56 38.4 Unemployed 56 38.4 5 Ethnicity Hausa 11 7.5 Igbo 131 89.7 Yoruba 2 1.4 Others 2 1.4 6 Highest level of Education No formal education 13 8.9 Primary education 14 9.6 Secondary education 94 64.4 Tertiary education 25 17.1 7 . Income of per month(in ₦) Less than 50,000 138 94.5 Above 50,000 8 5.5 8 Income of Spouse per month(in ₦) Less than 50,000 107 73.3 Above 50,000 27 18.5 Unknown 12 8.2 9 Parity Less than 4 119 81.5 4 and above 27 18.5 10 CD4 Count <350 26 17.8 (b) >350 68 46.6 Unknown 52 35.6 tertiary health institutions in Anambra State, Nigeria and reason(s) for non-adherence.The general purpose of this study was to ascertain the level of adherence to Option B+ ART among HIV positive pregnant women attending antenatal clinics at tertiary health institutions Anambra State, Nigeria and to determine reason(s) for non-adherence. MATERIALS AND METHODS Cross-sectional descriptive survey design was utilized in the study to determine the level of adherence to option B+ antiretroviral therapy among HIV positive pregnant women attending antenatal clinics at tertiary health institutions in Anambra state. This study was conducted in the tertiary health institutions in Anambra State, Nigeria. There are two tertiary health institutions in Anambra State, Nigeria which include NnamdiAzikiwe University Teaching Hospital (NAUTH), Nnewi and ChukwuemekaOdimegwuOjukwu University Teaching Hospital (COOUTH), Awka. The study population was 230 HIV positive pregnant women who attend antenatal clinics at tertiary health institutions in Anambra state for one year. The sample size for the study is 146 which was calculated with Yaro Yamane formula. Convenient and purposive sampling techniques were used in the selection of the participants. The instrument for data collection was Adult AIDS Clinical Trial Group (AACTG) standardized questionnairewhich was validated by a statistician and an expert in maternal and child health Nursing. A total of 146 copies of the questionnaire were distributed and were all retrieved. Consent of the respondents was sought, confidentiality of information supplied by the respondents during and after the procedure was ensured and anonymity was also ensured by their names not appearing on the questionnaire. Also, ethical approval was obtained from the ethical committees of the tertiary health institutions (NAUTH and COOUTH). Data were analysed using IBM SPSS software database (version 25). Tables were used to present date.
- 3. Silas Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955 7954 Table 1.1 showed that majority of the women 101(67.8%) were in the age range of 26-35 years, followed by 41(27.5%) within the age range of 15-25 years then 6(4.0%) in the age range of 36-45 years and finally 1(0.7%) in the age range of 46-55 years. Also, majority of the women 145(97.3%) were Christians, 1(0.7%) was a traditionalist, 1(0.7%) of the respondents was a muslim and 2(1.3%) fell under ‘others’ (atheists). Majority of the respondents were married (148(99.3%) and 1(0.7%) was divorced. 73(49.0%) of the women were into business, 44(29.5%) were professionals while 32(21.5%) are unemployed. 144(96.6%) of the women were Ibos, 2(1.3%) followed by those from other ethnic groups (2(1.3%) while 1(0.7%) of the respondents were Hausas. 99(66.4%) of the women had tertiary education, 45(30.2%) stopped at secondary school while 5(3.4%) of the respondents had no formal education. 72(48.3%) of the respondents had a child less than five years, 43(28.9%) had two children less than five years, 21(14.1%) had three children below five years while 13(8.7%) had four children less than five years of age. Research Question 1: What is the level of adherence of the HIV positive pregnant women to option B+ ART? Table 1.2: The self-reported Adherence of the HIV Positive Pregnant Women to Option B+ ART n=146 Adherence to option B+ ART n (%) Percentage (%) Adherent 130 89.0 Non-adherent 16 11.0 Total 146 100.0 Have you skipped taking pills before? No 113 77.4 Yes 33 22.6 Total 146 100.0 When last did you skip a pill? n=33 Within last four days 10 30.3 Yesterday 3 9.1 Day before yesterday 3 9.1 Last weekend (Saturday and/or Sunday) 4 12.1 Within last two weeks 12 36.4 Within last four weeks 1 3.0 Total 33 100.0 Table 1.2 shows that130(89%) HIV positive pregnant women that were part of the study are adherent to Option B+ ART while 16(11%) of the women are not. 33 (22.6%) have skipped their drugs before while 113(77.4%) have not skipped their drugs before. Out of the 33 that have skipped their drugs before, 10 skipped it within the last four days, 3 skipped yesterday, 3 skipped a day before, 4 skipped last weekend, 12 skipped within last 2 weeks and only one skipped within last four weeks as at the time the questionnaires were administered. Table 1.3: Reasons for Missing ART Dose in the Past n=33 Reasons for missing ART dose in the past (multiple responses) n = 33 Yes (%) No (%) Simply forgot 12(36.4) 21(63.6) Away from home 11(33.3) 22(66.7) Busy with other things 5(15.2) 28(84.8) Had a change in daily routine 1(3.0) 32(97.0) Fell asleep/slept through dose 2(6.0) 31(94.0) Had problems taking drugs at specific times 1(3.0) 32(97.0) Felt ill or sick 4(12.1) 29(87.9) Wanted to avoid side effects 3(9.0) 30(91.0) Felt depressed/overwhelmed 1(3.0) 32(97.0) Had too many pills to take 1(3.0) 32(97.0) Did not want others to notice me taking drugs 2(6.0) 31(94.0) Felt drug was toxic 3(9.0) 30(91.0) The above are the reasons for missing Option B+ ART by the sixteen women that missed their medication in the last four days. Major reason by the women was forgetfulness 12(36.4), followed by being away from home 11(33.3%), busyness 5(15.2), illness 1(12.1%), feeling that drug is toxic 3(9%), side effects 3(9%), change in daily routine 1(3%), issue taking drugs 1(3%), depression 1(3%), too many pills to take 1(3%). DISCUSSIONS Research Question 1: What is the level of adherence of the HIV positive pregnant women to option B+ ART? It was discovered from the study that 130(89%) of the HIV positive pregnant women adhered to option b+ ART while 16(11%) of the women were not adherent to their drugs. A respondent is considered adherent if shehasnot missedtaking anydosesovera 4-dayperiodpriordayofsurvey. Missing at least one dose over the 4 days’ period prior day of survey is considered as non-adherent. This entails that majority of the HIV positive pregnant women that participated in this study showed good adherence to Option B+ ART. This revealed that majority of the HIV positive pregnant women that participated in this study showed good adherence to Option B+ ART. This is likely due to the effort of the mentor mothers and nurses in counselling the women on the need for adherence to their medications. This finding is line with the findings of Ebuyet al. [8] In their study, they determined the level of adherence to Option B+ PMTCT drugs and factors associated with adherence among HIV positive pregnant women in public hospitals of Northern Ethiopia. From their findings, 87.1% of their respondents were adherent to Option B+ ART which they described as reasonably good. Also, Mukoshaet al.[9] in their study in Lusaka Zambia discovered that 81.7% of their respondents were adherent to their medication (ART).However, the findings contrast that of Oginniet al.[7] which showed that only 47% of the respondents adhered to their drug regimen and that of Omonaiye, et al.[5] which pointed out that only 32.7% of the HIV positive women that took part in the study self-reported to have taken all ART doses in the past 96 hours following the study.The disparity in findings might be due to different level of efforts that was made in counselling and creating awareness on the need for adherence by the nurses and mentor mothers at different health facilities.
- 4. Reasons for non-adherence of the HIV positive pregnant 16(11%) of the women were not adherent to their drugs. They indicated the following as reasons: Forgetfulness, being away from home, busyness, change in daily routine, sleepiness, illness, side effect of drugs, depression, too many pills to take, hiding from others, feeling that drug is toxic, not wanting to be noticed by others while taking drugs. Forgetting to take their drugs and being away from home are both unintentional revealing that the majority of the women do not miss taking their drugs intentionally. Also being busy can make the women forget to take their drugs. The finding above is in line with that of Tesfaye and Melese [10] who determined adherence to antiretroviral therapy among people living with HIV/AIDS in Hara town and its surroundings, North Eastern Ethiopia. Their findings showed that participants who had never encountereddrugsideeffectswere2.69timesmorelikelytoadheretotheir ART medication than those who had ever encountered drug side effect. In agreement, Wondimu, et. al.[11] in their study in Central Ethiopia, found out that fear of stigma for taking ART was among the associated factors enhancing the adherence to PMTCT Option B+ care. Also Nthala, et al.[12] in their study discovered that adherence to ART was a challenge (low) that needed to be addressed and reasons for that included economic factors (lack of food), physical factors (side effects of the drugs), environmental factors (long waiting hours with long queues) and community factors (social stigma). Still in line with the above findings, Obonyo [13] from her findings opined that fear of discrimination and stigma (69.9%) also affected adherence to ART. Ebuyet al.[8]in their cross-sectional study identified that among the challenges for adherence to Option B+ PMTCT, forgetting to take the medications (92.3%) was the dominant obstacle, followed by the fear of side effects (38.5%). On the contrary, the study carried out by Chukwukaodinaka [14] in FCT, Abuja, Nigeria, revealed that PMTCT services were hindered by the following: permission from spouse before being tested, couple counselling not done, group posttest counselling, non-incorporation of family planning and low support group enrolment. The different reasons for non- adherence to ART might likely be due to the options in the questionnaire. It can also be due to different individuals that participated in and conducted the studies. Conclusion The level of adherence to Option B+ ART among HIV positive pregnant women attending the tertiary health institutions in Anambra state is good but there is still need for improvement to reach the peak which is 100% adherence so as to totally eliminate mother to child transmission of HIV. Acknowledgements – No acknowledgements Declaration of interest: The authors declare there is no conflict of interest of any form with regards to this study Funding sources: There was no external source of funding received for this study from any funding institutions or donor with regards to this study. References [1] WHO. The Global Health Observatory (Internet). 2023 (cited 2023 October). Available from https://www.who.int/data/gho/data/ themes/hiv-aids. [2] Onovo, A. A, Adeyemi, A., Onime, D., Kalnoky, M., Kagniniwa, B., Dessie, M., Lee, L., Parrish, D., Adebobola, B., Ashefor, G., Ogorry, O., Goldstein, R., and Meric, H. 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