Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Australia.
Int J Infect Dis. 2019 Apr;81:225-230. doi: 10.1016/j.ijid.2019.02.014. Epub 2019 Feb 18.
Nigeria has the highest rate of mother to child transmission of HIV (MTCT) in the world. By 2015, all Global Plan priority countries, except Nigeria, had adopted the Option B+ programme. Nigeria finally adopted Option B+ in 2016 with full implementation reported in 2017. We examined adherence to antiretroviral therapy (ART) among pregnant women since the rollout of Option B+ in Nigeria.
A cross sectional approach was adopted that involved dissemination of a survey (Adult AIDS Clinical Trial Groups [AACTG] standardised survey) to HIV positive pregnant women, to assess adherence to ART. This study was conducted from February to June, 2018 in four health care sites in Akwa Ibom State, in the South-South region of Nigeria. Bootstrapping was used to estimate the 95% confidence interval of the prevalence of adherence. Bivariate associations between patient demographic characteristics and medication taking behaviours, and the outcome variable of ART adherence were examined using Chi-square tests. Multivariable logistic regression was used to identify factors independently associated with adherence.
Of the 275 women (response rate=92.6%), 32.7% (95% CI: 26.9-38.5) self-reported taking all ART doses in the past 96 hours. In the multivariable logistic regression analyses, there were positive associations between an increased education level (OR=1.7, p=0.006) and disclosure of HIV status (OR=2.3, p=0.024), and medication adherence. For women who had previous prevention of MTCT exposure, the odds of medication adherence were 2.5 times higher compared with those with no previous MTCT exposure (OR=2.5, p=0.005).
Adherence to ART among pregnant women in Nigeria is low. There is a need to improve adherence during pregnancy under the Option B+ programme in Nigeria.
尼日利亚是世界上母婴传播艾滋病毒（MTCT）率最高的国家。到 2015 年，除尼日利亚外，所有全球计划优先国家都已采用 B+方案。尼日利亚最终在 2016 年采用 B+方案，并于 2017 年全面实施。我们调查了自尼日利亚推出 B+方案以来，孕妇对艾滋病抗病毒治疗（ART）的依从性。
我们采用了一种横断面研究方法，向艾滋病毒阳性孕妇分发了一份调查（成人艾滋病临床试验组[AACTG]标准化调查），以评估其对 ART 的依从性。本研究于 2018 年 2 月至 6 月在尼日利亚南部阿克瓦伊博姆州的四个医疗保健点进行。Bootstrapping 用于估计依从性的 95%置信区间。使用卡方检验检查患者人口统计学特征与服药行为以及 ART 依从性结果变量之间的二变量关联。使用多变量逻辑回归确定与依从性独立相关的因素。
在 275 名妇女中（应答率为 92.6%），32.7%（95%CI：26.9-38.5）自我报告在过去 96 小时内服用了所有 ART 剂量。在多变量逻辑回归分析中，教育程度提高（OR=1.7，p=0.006）和 HIV 状态披露（OR=2.3，p=0.024）与药物依从性呈正相关。对于有预防母婴 MTCT 暴露史的妇女，与没有 MTCT 暴露史的妇女相比，药物依从的几率高 2.5 倍（OR=2.5，p=0.005）。
尼日利亚孕妇对 ART 的依从性较低。在尼日利亚的 B+方案下，需要提高怀孕期间的依从性。
