Implementation of lifelong ART (Option B+) for Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Uganda
Background:  Uganda started implementing lifelong antiretroviral therapy (ART) [Option B+] use for the prevention of mother-to-child transmission (PMTCT) in September 2012 with commendable results. However, despite tremendous progress and successes noted, recent data show that several challenges and information gaps in preparedness, organization of PMTCT services, uptake, and adherence to lifelong ART, still exist which stagnate the progress to elimination of mother-to-child transmission of HIV. Objectives: 1. To explore health providers' perspectives on health facility preparedness and organization in the implementation of lifelong ART for PMTCT; 2. To assess uptake, early adherence, and associated factors among expectant and lactating mothers living with HIV on lifelong ART for PMTCT of HIV; 3. To determine suboptimal adherence to lifelong ART, and its predictors among pregnant and breastfeeding women living with HIV; and 4. To explore health providers’ perspectives of challenges and countermeasures in the implementation of lifelong ART for PMTCT. Methods: This study was conducted in Central Uganda in Masaka, Mityana, and Luwero districts in six purposively selected public health facilities using a mixed methods approach.  Results: Ninety-one percent of the women (463/507) received a prescription for lifelong ART. Of these, 93.3% (432/463) started swallowing their medicines. The 30-day suboptimal adherence was highest at month 2 (23.2%) but varied between 12%-13.9% at months 4, 6, 10, 14, and 18 post-study enrolment. Disclosure of HIV-positive status, AOR = 0.50 (0.30 – 0.84), spousal support, AOR = 0.43 (0.28 – 0.67), and health providers’ motivation, AOR = 0.19 (0.07 – 0.51) were associated with lower odds of suboptimal adherence. Unreadiness to start ART, AOR = 2.38 (1.26 – 4.50), and HIV-related stigma, AOR =1.70 (1.05 – 2.75)  were associated with higher odds of suboptimal adherence. Adequate counseling, willingness to start, and knowing the benefits of ART facilitated ART uptake. Training, supervision, and mentorship of frontline health providers were key for preparedness while counseling and support mechanisms for mothers were crucial under organization of lifelong ART PMTCT services. Challenges included 1) inadequacy of HIV service delivery; 2) Non-utilization of HIV services; and 3) Suboptimal treatment adherence. Countermeasures included on-job training, mentorship, task shifting, ongoing counseling, and peer support. Conclusions: Uptake of lifelong ART for PMTCT was very high. However, suboptimal adherence was a major concern. Disclosure of HIV- positive status, spousal support, and receiving motivation from health providers to start ART reduced the risk of suboptimal adherence.  Several challenges continue to impede the implementation of lifelong ART for PMTCT services.
Antwerp : University of Antwerp, Faculty of Medicine and Health Sciences, Global Health Institute , 2024
210 p.
Supervisor: Van geertruyden, Jean-Pierre [Supervisor]
Supervisor: Bastiaens, Hilde [Supervisor]
Supervisor: Wanyenze, Rhoda [Supervisor]
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Creation 07.02.2024
Last edited 18.06.2024
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