title: Adherence to combination prophylaxis for prevention of mother-to-child-transmission of HIV in Tanzania.
abstract: BACKGROUND
  Since 2008, Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT) recommend combination regimen for mother and infant starting in gestational week 28. Combination prophylaxis is assumed to be more effective and less prone to resistance formation compared to single-drug interventions, but the required continuous collection and intake of drugs might pose a challenge on adherence especially in peripheral resource-limited settings. This study aimed at analyzing adherence to combination prophylaxis under field conditions in a rural health facility in Kyela, Tanzania.
  
  
  RESULTS
  A cohort of 122 pregnant women willing to start combination prophylaxis in Kyela District Hospital was enrolled in an observational study. Risk factors for decline of prophylaxis were determined, and adherence levels before, during and after delivery were calculated. In multivariate analysis, identified risk factors for declining pre-delivery prophylaxis included maternal age below 24 years, no income-generating activity, and enrolment before 24.5 gestational weeks, with odds ratios of 5.8 (P = 0.002), 4.4 (P = 0.015) and 7.8 (P = 0.001), respectively. Women who stated to have disclosed their HIV status were significantly more adherent in the pre-delivery period than women who did not (P = 0.004). In the intra- and postpartum period, rather low drug adherence rates during hospitalization indicated unsatisfactory staff performance. Only ten mother-child pairs were at least 80% adherent during all intervention phases; one single mother-child pair met a 95% adherence threshold.
  
  
  CONCLUSIONS
  Achieving adherence to combination prophylaxis has shown to be challenging in this rural study setting. Our findings underline the need for additional supervision for PMTCT staff as well as for clients, especially by encouraging them to seek social support through status disclosure. Prophylaxis uptake might be improved by preponing drug intake to an earlier gestational age. Limited structural conditions of a healthcare setting should be taken into serious account when implementing PMTCT combination prophylaxis.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Kirsten
authors.forename: Julius
authors.initials: J
authors.lastname: Sewangi
authors.forename: Andrea
authors.initials: A
authors.lastname: Kunz
authors.forename: Festo
authors.initials: F
authors.lastname: Dugange
authors.forename: Judith
authors.initials: J
authors.lastname: Ziske
authors.forename: Brigitte
authors.initials: B
authors.lastname: Jordan-Harder
authors.forename: Gundel
authors.initials: G
authors.lastname: Harms
authors.forename: Stefanie
authors.initials: S
authors.lastname: Theuring
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D004359:Drug Therapy, Combination; D005260:Female; D006678:HIV / Q000472:pathogenicity*; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D013636:Tanzania; D013997:Time Factors; D055815:Young Adult; D015215:Zidovudine / Q000494:pharmacology
chemical_list: D015215:Zidovudine