Self-efficacy and antiretroviral therapy adherence among HIV positive pregnant women in South-West Nigeria: a mixed methods study

Background: In Nigeria, an estimated 60,000 paediatric HIV infections occur annually mainly through mother-to-child transmission. Adherence to antiretroviral therapy (ART) in pregnancy is crucial in preventing new paediatric HIV infections. We investigated HIV-treatment adherence self-efficacy and ART adherence among HIV-positive pregnant women in South-West Nigeria.
Methods: A mixed method approach was employed using a sequential explanatory strategy in which HIV-positive pregnant women were recruited from three facilities providing Prevention of Mother-to-Child Transmission (PMTCT) services. Self-efficacy and adherence were assessed using the HIV-Treatment Adherence Self-efficacy Scale and the Centre for Adherence Support Evaluation Index Tool, respectively. A focus group discussion and key informant interviews were used to explore barriers and motivating factors to ART adherence in pregnancy. Quantitative data were analysed using descriptive statistics and logistic regression at 5% significance level, while thematic content analysis was used to analyse qualitative data.
Results: A total of 126 women participated in the study. The mean age and mean gestational age of respondents were 32.7 ± 4.58 years and 24.4 ± 7.41 weeks, respectively. The prevalence of good adherence and HIV-treatment adherence self-efficacy were 70.6% and 26.2%, respectively. Low self-efficacy (OR=0.2, 95%CI=0.05– 0.53, p<0.05) was statistically associated with poor adherence. Planned pregnancy (OR=3.1, 95%CI=1.23-7.72, P<0.05) increased the likelihood for ART adherence. Looking healthier and protecting unborn babies were motivators to adherence while stigmatization and negative spousal influences were barriers to adherence.
Conclusion: Low HIV-treatment adherence self-efficacy was related to poor adherence in pregnancy. Interventions aimed at improving adherence in pregnancy should also focus on HIV-treatment adherence self-efficacy.