title: Challenges in PMTCT antiretroviral adherence in northern KwaZulu-Natal, South Africa.
abstract: BACKGROUND
  Women living with HIV in sub-Saharan Africa face significant challenges in accessing HIV care and adhering to antiretroviral therapy. Most reports have focused on issues relating to long-term adherence such as those surrounding stigma and disclosure, hunger, cultural factors, lack of accurate health information, lack of social support, medication side effects and overcrowded health systems. Information related to the challenges facing pregnant women when taking antiretrovirals for prophylactic purposes is limited. The "Kesho Bora Study" is a multicentre prevention of mother-to-child transmission (PMTCT) trial in sub-Saharan Africa evaluating the PMTCT efficacy of triple therapy until cessation of breast feeding compared to short course zidovudine monotherapy in a predominantly breast feeding population. Following unexplained discrepancies during objective adherence assessments, a sub-study was conducted at one site to examine the underlying adherence issues.
  
  
  METHODS
  The counselling and clinical notes of all 100 enrolled Zulu women were examined. Extracted information was supplemented by unstructured, free-ranging interviews conducted by trained adherence counsellors on 43 consecutive women attending the trial clinic over a two-week period. Adherence was defined as good (>95% adherence), or poor (<95% adherence).
  
  
  RESULTS
  Reasons provided for sub-optimal adherence included therapy misconceptions/misunderstandings, antiretroviral use by relatives, domestic violence, poverty and issues relating to disclosure and stigma. About 61% (57/94) of antenatal women had good adherence with their PMTCT prophylaxis, with no significant difference shown between those taking the long and short course.
  
  
  CONCLUSIONS
  Antenatal women in northern rural KwaZulu-Natal face significant challenges in taking antiretroviral PMTCT prophylaxis.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa. smepham@africacentre.ac.za
authors.forename: S
authors.initials: S
authors.lastname: Mepham
authors.forename: Z
authors.initials: Z
authors.lastname: Zondi
authors.forename: A
authors.initials: A
authors.lastname: Mbuyazi
authors.forename: N
authors.initials: N
authors.lastname: Mkhwanazi
authors.forename: M L
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents; D044383:Black People / Q000208:ethnology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology / Q000635:transmission*; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000208:ethnology*; D056990:Post-Exposure Prophylaxis; D011247:Pregnancy; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents