title: 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.
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.
  
  
  CONCLUSIONS
  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.
authors: Department of Obstetrics and Gynaecology, Muhimbili National Hospital, P,O, Box 65561, Dar es Salaam, Tanzania. mmosi_2@yahoo.com.
authors: Matilda
authors: M
authors: Ngarina
authors: Rebecca
authors: R
authors: Popenoe
authors: Charles
authors: C
authors: Kilewo
authors: Gunnel
authors: G
authors: Biberfeld
authors: Anna Mia
authors: AM
authors: Ekstrom
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008427:Maternal Health Services; D008875:Middle Aged; D010349:Patient Compliance; D011181:Postnatal Care; D011247:Pregnancy; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013636:Tanzania; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
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