Impact of Antiretroviral Prophylaxis Adherence on Mothers Health and Prevention-of-Mother-to-Child-Transmission (PMTCT) of HIV/AIDS among Seropositive Pregnant Women Attending HIV Treatment Centre in Abeokuta, Nigeria
Background: Adherence of HIV seropositive pregnant women to antiretroviral (ARV) prophylaxis determines the success of prevention of mother to child transmission (PMTCT) of HIV interventions and there is a need to evaluate this in a resource limited setting like Nigeria. Methods: A cross-sectional study was conducted to evaluate the socio-economic factors, knowledge and adherence of fourty consented sero-positive pregnant women to Antiretroviral (ARV) prophylaxis for their own health and Prevention of Mother to Child Transmission (PMTCT) of HIV/AIDS using semi-structured questionnaire. Mothers’ blood samples were analyzed for CD4+ count, HIV-Syphilis and HIV-HB co-infections, lipid profile, creatinine, serum enzymes and electrolytes using standard methods. Early infant diagnosis (EID) using PCR was conducted for HIV exposed infants. Data were analyzed using SPSS version 16. Results: The Study showed that all the mothers (100%) were on ARV consisting Zidovudine (AZT), Lamivudine (3TC) and single dose Nevirapine (NVP) while all the HIV exposed babies (100%) received 1.5ml daily dose nevirapine from birth to their first EID. Moderate adherence was observed in 90% of the mothers while 2.5% of them were low in adherence. Among socio-economic factors examined, only age was associated with good adherence. Adherence was also found to be statistically significant with mothers’ platelets, creatinine and electrolytes level. Majority (92.5%) of the infants were HIV negative showing a high prevention rate. Conclusion: Moderate adherence and high reduction in mother-to child-transmission (MTCT) was observed in this study. Only mothers’ CD4+ count was found to be statistically significant with infants’ EID results at P<0.05, emphasizing the import of mothers immunologic and viral factors.
Adherence, Antiretroviral Prophylaxis, Prevention-of-Mother-to-Child-Transmission, HIV, CD4+ Count, EID
[1]
WHO (2011). HIV Drug resistance fact sheets, April 2011. HIV/AIDS programme.
[2]
FMH (2009). Federal Ministry of Health. Technical Report 2008 National HIV sero-prevalence sentinel survey among women attending antenatal clinics in Nigeria. National AIDS/STI Control Programme (NASCP). Abuja, 2009.
[3]
FGN (2009). Federal Government of Nigeria. National policy on HIV/AIDS. October 2009.
[4]
Adeleke, S.I., Mukhtar-Yola, M., Gwarzo, G.D. (2009). Awareness and knowledge of mother-to-child transmission of HIV among mothers attnending the paediatric HIV clinic, Kano, Nigeria. Annals of African Medicine 8(4): 210-214.
[5]
UNAID/WHO (2009). AIDS epidemic update. Geneva, UNAIDS, 2009 (http://www.unaids.org/en/dataanalysis/epidemiology/2009aidsepidemicupdate (accessed 25 November 2011).
[6]
WHO/UNAIDS/UNICEF (2011). Global HIV/AIDS response: Epidemic update and health sector progress towards Universal Access 2011 Progress Report.
[7]
UNAIDS (2008). Global Report on the AIDS Epidemic. Geneva, Switzerland: UNAIDS.2008.
[8]
Sturt, A.S., Dokubo, E.K., Sint, T.T. (2010). Antiretroviral therapy (ART) for treating HIV infection in ART-eligible pregnant women. Cochrane Database Syst Rev. 3:CD008440.
[9]
FHI (2005). Preventing Mother-To-Child Transmission of HIV. A Strategic Framework. Family Health International Institute for HIV/AIDS.
[10]
FMH (2005). Federal Ministry of Health. National guidelines on prevention of mother to child transmission of HIV in Nigeria. National AIDS/STI Control Programme (NASCP). Abuja, 2005.
[11]
Ayankoge, O.O., Omotola, B.D., Irem, V.A., Ahmed, O.A., Marafu, O.U. (2003). Knowledge, attitudes, beliefs and behavorial practice for creating awareness about HIV/AIDS in Lagos State, Nigeria. Niger Med Pract. 44: 7-10.
[12]
Ahmed, O., Odunukwe, N., Raheem, Y., Efienemokwu, C., Junaid, M., Adesesan, S., Ogedengbe, O., Harry, T., Salako, L. (2004). Knowledge, attitudes and perceptions of HIV/AIDS among traditional birth attendants and herbal practitioners in Lagos State, Nigeria. African Journal AIDS Research 3(2):191-196.
[13]
Igwegbe A.O., Ilika, A.L. (2005). Knowledge and perceptions of HIV/AIDS and mother to child transmission among antenatal mothers at Nnamdi Azikiwe University Teaching hospital, Nnewi. Nigerian Journal of Clinical Practice. 8(2):97-101.
[14]
Abiodun, M.O., Ijaiya, M.A., Aboyeji, P.A. (2007). Awareness and knowledge of mother- to child-transmission of HIV among pregnant women. J. Natl. Med. Assoc. 99: 758-763.
[15]
Ejikeme, B.N., Umeora, O.U.J. and Obuna, J.A. (2007). HIV/AIDS: awareness and practice among traditional birth attendants in rural Nigeria. Nigerian Medical Practitioner 51(1/2):6-10.
[16]
Inem, V., Kanu, R. and Atere, A.A. (2008). Baseline knowledge, practices and experiences of traditional birth attendants (TBAs) on HIV/AIDS before commencement of training for Prevention of Mother To Child Transmission of HIV (PMTCT) in South West Nigeria. Nigerian Medical Practitioner; 53(6):103-109.
[17]
Adeleke, S.I., Mukhtar-Yola, M., Gwarzo, G.D. (2009). Awareness and knowledge of mother-to-child transmission of HIV among mothers attnending the paediatric HIV clinic, Kano, Nigeria. Annals of African Medicine 8(4): 210-214.
[18]
Balogun, M. and Odeyemi, K. (2010). Knowledge and practice of prevention of mother-to-child transmission of HIV among traditional birth attendants in Lagos State, Nigeria. Pan African Medical Journal 5: Issue 7.
[19]
WHO (2010). Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach– 2010 version. WHO Library Cataloguing-in-Publication Data.
[20]
Chama, C., Gashau, W. and Oguche, S. (2007). The value of highly active antiretroviral therapy in the prevention of mother-to-child transmission of HIV. Journal of Obstetrics and Gynecology; 27 (2): 134 - 137.
[21]
Homsy, J., Meyer, M. and Levy, J.A. (1990). Serum enhancement of human immunodeficiency virus (HIV) correlates with disease in HIV infected individuals. Journal of Virology 64:1437–1440.
[22]
Ikechebelu J. I., Ugboaja, J. O., Kalu, S. O. and Igboelina, D.O. (2009). Outcome of prevention of mother to child transmission (PMTCT) of HIV infection programme in Nnewi, Southeast Nigeria. In: Proceedings of the 43rd Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria held in Kano.
[23]
Ekama, S.O., Herbertson, E. C., Addeh, E. J., Gab-Okafor, C.V, Onwujekwe, D. I., Tayo, F. and Ezechi, O.C. (2012). Pattern and determinants of antiretroviral drug adherence among Nigerian pregnant women. Journal of Pregnancy 85: 1810.
[24]
Day, J N., Godoka, P., and Nyamafeni et al. (2002). Adherence to ART in clinical trial settings in Zimbabwe and Uganda: lessons learned. In: Proceedings of the International AIDS Conference, Bangkok, Thailand.
[25]
Markos, E.A. and Davey,G. (2008). Adherence to ART in PLWHA at Yirgalem Hospital, South Ethiopia. Journal of Health & Development 22: 174–179.
[26]
Jones, A. and Barthlomew C. (2005). Adherence to antiretroviral therapy in pregnant women at an HIV treatment clinic. Proceedings of the 3rd International AIDS Society Conference on HIV Pathogensis, Treatment and Prevention, Port of Spain Trinidad, Abstract No. TUPEC 5.5. p18.
[27]
Owoaje, E.T, Omidokun A.D., and Ige O.K. (2012). Knowledge and perception of Prevention of Mother to Child services amongst pregnant women accessing antenatal clinic in a Primary Health Care centre in Nigeria. African Journal of Primary Health Care Family Medicine 4(1).
[28]
Zoufaly, A., Onyoh, E.F., Tih, P.M., Awasom, C.N. and Feldt, T.I. (2012). Syphilis and Hepatitis B Co-infection among HIV-Infected, Sex-Trafficked Women and Girls in Nepal. J STD AIDS.
[29]
Silverman, J.G. Decker, M.R., Gupta, J., Dharmadhikari, A., Seage, G.R. and Raj, A . ( 2010). High prevalence of hepatitis B and syphilis co-infections among HIV patients initiating antiretroviral therapy in the north-west region of Cameroon. International Journal of Medicine and Medical Sciences 2: 238–245.
[30]
Dyer, J.R., Eron, J.J. and Hoffman, I.F. (1998). Association of CD4+ cell depletion and elevated blood and seminal plasma human immunodeficiency virus type 1 (HIV-1) RNA concentrations with genital ulcer disease in HIV-1-infected men in Malawi. Journal of Infectious Dieases 177:224-227.
[31]
Buchacz, K., Pate, P. and Taylor, M. S. (2004). Syphilis increases HIV viral load and decreases CD4+ cell counts in HIV-infected patients with new syphilis infections. AIDS. 18: 2075.
[32]
Sadiq, S.T., McSorley, J. and Copas, A.J. (2005). The effects of early syphilis on CD4+ counts and HIV-1 RNA viral loads in blood and semen. Sex Transmission Infection 81:380-385.
[33]
Kofoed, K., Gerstoft, J., Mathiesen, L.R.and Benfield, T. (2006). Syphilis and human immunodeficiency virus (HIV)-1 coinfection: influence on CD4+ T-cell count, HIV-1 viral load, and treatment response. Sexually Transmitted Diseases 33:143-148.
[34]
Quinn ,T.C., Wawer, M.J. and Sewankambo, A. (2000). Viral load and heterosexual transmission of Human Immunodeficiency Virus type 1. New England Journal of Medicine. 342: 921-929.
[35]
Baeten, J.M. and Overbaugh, J. (2003). Measuring the infectiousness of persons with HIV-1: opportunities for preventing sexual HIV-1 transmission. Current HIV Research. 1:69-86.
[36]
Gil, P., de Górgolas, M., Estrada, V., Arranz, A., Rivas, P., and Year, C. (2004). Long-term efficacy and safety of protease inhibitor switching to nevirapine in HIV-infected patients with undetectable virus load. CID 39:1024-1029.
[37]
Fisac, C., Fumero, E., Crespo, M., Roson, B., Ferrer, E., and Virgili, N. (2005). Metabolic benefits 24 months after replacing a protease inhibitor with abacavir, efvirenz or nevirapne. AIDS 7;19: 917-925.
[38]
Kamga, H.L.F., Assob, J.C.N., Njunda, A.L., Nde Fon, P., Nsagha, D.S., Atanga, M.B.S., Weledji, P., Puinta, D.P., and Achidi, E.A. (2011). The kidney function trends in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients at the Nylon District Hospital, Douala, Cameroon. Journal of AIDS HIV Res;3(2):30-37.
[39]
Emejulu, A. A., Onwuliri, V. A., and Ojiako, O. A. (2011). Electrolyte Abnormalities and Renal Impairment in Asymptomatic HIV-infected Patients in Owerri, South Eastern Nigeria. Australian Journal of Basic and Applied Sciences, 5(3): 257-260.
[40]
Meldrum, J. (2003). Nevirapine-based fixed dose combination ARVs. GMHC Treat Issues; 17:5-9.
[41]
Hunt, P.W., Martin, J. N. and Sinclar, E. (2003). T-Cell activation is associated with lower CD4+ T Cell gains in human immunodeficiency Virus –infected patients with sustained viral suppression during antiretroviral therapy. Journal of infectious Disease, 187: 1534-1543.
[42]
Dahl, V., Mellhammar, L., Bajunirwe, F. and Bjorkman, P. (2008). Acceptance of HIV testing among women attending antenatal care in south-western Uganda: Risk factors and reasons for test refusal. AIDS Care. 20(6)746–752.
[43]
WHO (2006). HIV and infant feeding update. Technical consultation held on behalf of the Inter-Agency Task Team on prevention of HIV infections in pregnant women, mothers and their infants. Available from: http://www.who.int/hiv/mediacentre/Infantfeedingconsensusstatement.pdf [Accessed February 2012].
[44]
Coovadia, H.M., Rollins, N.C. and Bland, R.M. (200l). Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 369(9567): 1107–1116.
[45]
NACA (2011). National Agency for the Control of AIDS Fact Sheet: PMTCT in Nigeria. http://naca.gov.ng/ Content/View/399/Lang, En/ (Accessed July 2013).
[46]
Anoje, C., Aiyenigba, B., Suzuki, C. Badru, T., Akpoigbe, K. Odo, M., Odafe, S., Adedokun, O., Torpey, K. and Chabikuli, O. N. (2012). Reducing mother-to-child transmission of HIV:findings from an early infant diagnosis program in south-south region of Nigeria. BMC Public Health 12:184.
[47]
Mnyani, C., McIntyre, J. and Struthers, H. (2009). Reducing PMTCT in practice: results from a successful model of a PMTCT program in a high prevalence HIV urban setting. Abstract #TUPEC048. Presented at: 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention Cape Town, South Africa.
[48]
FMH (2007). Federal Ministry of Health: National Guidelines on Prevention of Mother-to-child Child-Transmission of HIV (PMTCT). Abuja, Nigeria.
