Factors affecting adherence to antiretroviral therapy among pregnant women in theEastern Cape, South Africa

Background:Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant womenliving with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention ofmother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examinedadherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in thePMTCT programme in the Eastern Cape, South Africa.Methods:This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. Weconducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016.Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n= 177)were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used todetermine the independent predictors of ART non-adherence.Results:A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, afteradjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family memberwere the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the mainreasons for non-adherence to ART.Conclusions:Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated withlifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV,clinicians need to screen for these factors at every antenatal clinic visit.Keywords:Adherence, Non-adherence, HIV, Antiretroviral therapy, Elimination of mother-to-child transmission,Prevention of mother-to-child transmission, Stigma, South Afric