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.
BACKGROUND
The Prevention of Mother to Child Transmission of HIV (PMTCT) programme was introduced at Bindura Hospital in 2003. Seven additional satellite PMTCT clinics were set up in the district to increase service coverage but uptake of PMTCT interventions remained unsatisfactory. In this study we determined the prevalence of and factors associated with non-adherence to the single dose nevirapine (SD-NVP) regimen for PMTCT in Bindura town.


METHODS
An analytic cross-sectional study was conducted in four health institutions in Bindura town. Participants were mother-baby pairs on the PMTCT programme attending routine six weeks post natal visits in the participating health institutions from March to July 2008. We interviewed 212 mothers using a structured questionnaire.


RESULTS
The non-adherence rate to the maternal nevirapine dose was 30.7%, while non-adherence to the newborn nevirapine dose was 26.9%. The combined mother-baby pair nevirapine non-adherence was 42.9%. Non-adherence to the maternal dose of nevirapine was associated with lack of maternal secondary education (POR = 2.38; 95%CI: 1.05-3.39) and multi-parity (POR = 2.66; 95%CI: 1.05-6.72), while previous maternal exposure to the PMTCT programme (POR = 0.22; 95%CI: 0.08-0.57) and giving the mother a NVP tablet to take home during antenatal care (POR = 0.03; 95%CI: 0.01-0.09) were associated with improved maternal adherence to nevirapine. Non-adherence to the infant dose of nevirapine was associated with maternal non-disclosure of HIV results to sexual partner (POR = 2.75; 95%CI: 1.04-7.32) and home deliveries (POR = 48.76; 95%CI: 17.51-135.82).


CONCLUSIONS
Non-adherence to nevirapine prophylaxis for PMTCT was high in Bindura. Ensuring institutional deliveries, encouraging self-disclosure of HIV results by the mothers to their partners and giving HIV positive mothers nevirapine doses to take home early in pregnancy all play significant roles in improving adherence to PMTCT prophylaxis.
Kuonza
Lazarus R
LR
Department of Community Medicine, College of Health sciences, University of Zimbabwe, Harare, Zimbabwe. lkuonza@gmail.com
Tshuma
Clemence D
CD
Shambira
Gerald N
GN
Tshimanga
Mufuta
M
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D017533:Marital Status; D055118:Medication Adherence / Q000523:psychology*; D019829:Nevirapine / Q000008:administration & dosage*; D011247:Pregnancy; D012494:Sampling Studies; D012650:Self Disclosure; D011795:Surveys and Questionnaires; D015030:Zimbabwe / Q000453:epidemiology; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D019829:Nevirapine