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Open Access Highly Accessed Research article

Reasons for poor adherence to antiretroviral therapy postnatally in HIV-1 infected women treated for their own health: experiences from the Mitra Plus study in Tanzania

Matilda Ngarina156*, Rebecca Popenoe23, Charles Kilewo4, Gunnel Biberfeld56 and Anna Mia Ekstrom23

Author Affiliations

1 Department of Obstetrics and Gynaecology, Muhimbili National Hospital, P.O. Box 65561, Dar es Salaam, Tanzania

2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

3 Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

4 Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

5 Swedish Institute for Communicable Disease Control (SMI), Karolinska Institutet, Stockholm, Sweden

6 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden

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BMC Public Health 2013, 13:450  doi:10.1186/1471-2458-13-450

Published: 7 May 2013

Abstract

Background

In a study of prevention of mother-to-child transmission of HIV (PMTCT) by triple antiretroviral therapy (ART) in Dar es Salaam, Tanzania (the Mitra Plus study), retrospective viral load testing revealed a high and increasing frequency of detectable viral load during follow-up for two years postnatally in women given continuous ART for their own health suggesting poor adherence. This study explored women’s own perceived barriers to adherence to ART post-delivery so as to identify ways to facilitate better drug adherence among women in need of ART for their own health.

Methods

Semi-structured interviews were conducted with 23 of the 48 women who had detectable viral load at 24 months postnatally. Content analysis was used to analyze the data.

Results

Most women in the study did not acknowledge poor adherence until confronted with the viral load figures. Then, however, they revealed multiple reasons for failing to adhere. They said that their motivation to take ART decreased once they had protected their children from becoming infected and successfully weaned them. Feeling well for some, and a feeling of hopelessness for others, also decreased motivation to continue ART. The overwhelming demands of everyday life, poverty and lack of empowerment also posed significant barriers to long-term adherence. The need to keep their HIV status a secret and not let anyone see them taking the drugs was another steep barrier.

Conclusion

Reasons for postnatal failure to adhere by mothers put on ART for life during pregnancy included lack of motivation to continue ART after weaning the child, poverty and stigma. Projects that simultaneously address stigma, poverty and women’s lack of empowerment may be necessary for PMTCT and ART to reach their full potential. Our results indicate that the new WHO proposal to start all HIV-infected pregnant women on lifelong ART regardless of CD4 cell count needs to address the challenging realities of women in resource-poor contexts if it is to be successful.

Keywords:
Prevention of mother-to-child transmission; Postnatal; Antiretroviral drugs; Adherence; Tanzania