Background
Methods
Study design and settings
Participants
Measures
Statistical analysis
Qualitative data analysis
Ethical clearance
Results
Variables | Frequency (n = 1709) | Percentage |
---|---|---|
Marital Status | ||
Married | 312 | 18.3 |
Single | 1187 | 69.5 |
Co-habiting | 186 | 10.9 |
Divorce/Separated | 24 | 1.4 |
Place of Residence | ||
Rural | 585 | 34.2 |
Semi-urban | 792 | 46.3 |
Urban | 332 | 19.4 |
Educational Level | ||
No formal education | 5 | 0.3 |
Grade 1–6 | 115 | 6.7 |
Grade 7–12 | 1479 | 86.5 |
Tertiary | 110 | 6.4 |
Employment status | ||
Unemployed | 1277 | 74.7 |
Employed | 432 | 25.3 |
Smoking status | ||
Smoked during pregnancy | 100 | 5.9 |
Quit smoking during pregnancy | 80 | 4.7 |
Never smoked | 1529 | 89.5 |
Alcohol use | ||
Drank during pregnancy | 235 | 13.8 |
Quit drinking during pregnancy | 431 | 25.2 |
Never drank alcohol | 1043 | 61.0 |
aTrimester at booking | ||
First | 110 | 6.8 |
Second | 1177 | 73.2 |
Third | 322 | 20.0 |
Status at first visit | ||
Positive | 1382 | 80.9 |
Negative | 94 | 5.5 |
Unknown | 233 | 13.6 |
On ART at booking | 998 | 58.4 |
Proportion of women who were adherent
Variables | Adherence (n = 1098; 69%) | Non-adherence (n = 494; 31.0%) | p-value |
---|---|---|---|
Age | |||
< 25 years | 230(63.5) | 132(36.5) | 0.008 |
≥ 25 years | 863(70.4) | 362(29.6) | |
Marital Status | |||
Married | 230(76.9) | 69(23.1) | < 0.001 |
Single | 760(69.5) | 333(30.5) | |
Co-habiting | 95(54.0) | 81(46.0) | |
Divorce/Separated | 13(54.2) | 11(45.8) | |
Educational Level | |||
No formal education | 1(20.0) | 4(80.0) | 0.002 |
Grade 1–6 | 85(82.5) | 18(17.5) | |
Grade 7–12 | 947(68.4) | 438(31.6) | |
Tertiary | 65(65.7) | 34(34.3) | |
Employment Status | |||
Unemployed | 815(68.5) | 374(31.5) | 0.286 |
Employed | 283(70.2) | 120(29.8) | |
Smoking Habit | |||
Smoked during pregnancy | 33(39.3) | 51(60.7) | < 0.001 |
Quit smoking during pregnancy | 48(61.5) | 30(38.5) | |
Never smoked | 1017(71.1) | 413(28.9) | |
Alcohol Use | |||
Drank during pregnancy | 92(44.0) | 117(56.0) | < 0.001 |
Stopped during pregnancy | 266(64.9) | 144(35.1) | |
Never drank | 740(76.1) | 233(23.9) | |
HIV status at booking | |||
Positive | 914(70.9) | 376(29.1) | 0.003 |
Negative | 53(63.9) | 30(36.1) | |
Unknown | 131(59.8) | 88(40.2) | |
On ART at booking | |||
No | 263(71.7) | 104(28.3) | 0.373 |
Yes | 659(70.6) | 275(29.4) | |
Disclosure to partner | |||
No | 256(64.8) | 139(35.2) | 0.024 |
Yes | 836(70.3) | 353(29.7) | |
Disclosure to a family member | |||
No | 188(60.8) | 121(39.2) | < 0.001 |
Yes | 906(70.9) | 372(29.1) | |
Trimester at booking | |||
First | 95(57.2) | 71(42.8) | < 0.001 |
Second | 843(71.6) | 335(28.4) | |
Third | 160(64.5) | 88(35.5) |
Variables | Adherence (n = 1098; 69%) | Non-adherence (n = 494; 31.0%) | Unadjusted odd ratio | Adjusted odd ratio |
---|---|---|---|---|
Age | ||||
< 25 years | 230(63.5) | 132(36.5) | 1.36(1.06–1.74)* | 0.80(0.61–1.04) |
≥ 25 years | 863(70.4) | 362(29.6) | Ref | Ref |
Marital Status | ||||
Married | 230(76.9) | 69(23.1) | Ref | Ref |
Single | 760(69.5) | 333(30.5) | 1.40(1.04–1.87)* | 1.22(0.89–1.66) |
Co-habiting | 95(54.0) | 81(46.0) | 2.38(1.59–3.56)*** | 1.71(1.11–2.64)* |
Divorce/Separated | 13(54.2) | 11(45.8) | 2.79 (1.16–6.70)* | 3.24(1.33–7.91)* |
Educational Level | ||||
No formal education | 1(20.0) | 4(80.0) | 6.97(0.75–64-86) | 4.79(0.47–48.91) |
Grade 1–6 | 85(82.5) | 18(17.5) | 0.48(0.25–0.90)* | 0.51(0.26–0.98)* |
Grade 7–12 | 947(68.4) | 438(31.6) | 0.91(0.59–1.39) | 0.79(0.50–1.24) |
Tertiary | 65(65.7) | 34(34.3) | Ref | Ref |
Employment Status | ||||
Unemployed | 815(68.5) | 374(31.5) | 0.94(0.73–1.20) | |
Employed | 283(70.2) | 120(29.8) | Ref | |
Smoking Habit | ||||
Smoked during pregnancy | 33(39.3) | 51(60.7) | 4.0(2.45–6.53)*** | 1.91(1.10–3.33)* |
Quit smoking during pregnancy | 48(61.5) | 30(38.5) | 1.51(0.94–2.44) | 1.12(0.66–1.88) |
Never smoked | 1017(71.1) | 413(28.9) | Ref | Ref |
Alcohol Use | ||||
Drank during pregnancy | 92(44.0) | 117(56.0) | 3.80(2.76–5.24)*** | 3.19(2.23–4.56)*** |
Stopped duringpregnancy | 266(64.9) | 144(35.1) | 1.55(1.20–1.99)** | 1.38(1.05–1.80)* |
Never drank | 740(76.1) | 233(23.9) | Ref | Ref |
HIV status at booking | ||||
Positive | 914(70.9) | 376(29.1) | Ref | |
Negative | 53(63.9) | 30(36.1) | 1.08(0.66–1.77) | |
Unknown | 131(59.8) | 88(40.2) | 1.39 (1.02–1.89)* | |
On ART at booking | ||||
No | 263(71.7) | 104(28.3) | 1.28(0.98–1.67) | |
Yes | 659(70.6) | 275(29.4) | Ref | |
Disclosure to partner | ||||
No | 256(64.8) | 139(35.2) | 1.52(1.17–1.97)** | |
Yes | 836(70.3) | 353(29.7) | Ref | |
Disclosure to a family member | ||||
No | 188(60.8) | 121(39.2) | 1.30(1.02–1.66)* | 1.50(1.13–1.98)* |
Yes | 906(70.9) | 372(29.1) | Ref | Ref |
Trimester at booking | ||||
First | 95(57.2) | 71(42.8) | 1.22(0.69–2.16) | 1.34(0.74–2.42) |
Second | 843(71.6) | 335(28.4) | 0.73(0.55–0.97)* | 0.79(0.58–1.06) |
Third | 160(64.5) | 88(35.5) | Ref | Ref |
Reasons for non-adherence to ART
Variables | Frequency | Percent |
---|---|---|
Age | ||
Below 21 | 15 | 8.5 |
21–30 | 86 | 48.6 |
Above 30 | 76 | 42.9 |
Marital Status | ||
Married | 25 | 14.1 |
Single | 122 | 68.9 |
Co-habiting | 27 | 15.3 |
Divorce/Separated | 3 | 1.5 |
Place of Residence | ||
Rural | 57 | 32.2 |
Semi-urban | 90 | 50.8 |
Urban | 30 | 17.0 |
Educational Level | ||
No formal education | 2 | 1.1 |
Grade 1–6 | 8 | 4.5 |
Grade 7–12 | 160 | 90.3 |
Tertiary | 7 | 4.0 |
Employment status | ||
Unemployed | 148 | 83.6 |
Employed | 29 | 16.4 |
Trimester at booking | ||
First | 13 | 7.3 |
Second | 130 | 73.4 |
Third | 34 | 19.2 |
Status at first visit | ||
Positive | 154 | 87.0 |
Negative | 3 | 1.7 |
Unknown | 20 | 11.3 |
Theme 1: ART side effects
Some other women, who reported hallucinations, also stated that the medications made them feel dizzy, they experienced psychosis, had bad dreams, and saw dead people.“After taking the medication, I would feel dizzy. I see weird things like snakes or hear voices calling my name at night. I was constantly having nightmares, so I decided to stop taking the treatment.”
Theme 2: Patient-related factors
“I went to Transkei for 3 months, and I forgot to take my treatment book along; so the nurse in Transkei refused to give treatment without seeing my treatment book.”
Likewise, some women appeared to have purposefully left their medications behind when they visited their rural homes.“I moved to a new community and I could not afford taxi fare to come back for my transfer letter.”
“I stopped taking my treatment because I have no food and no money to go to the clinic.”
“I stopped using my medication because I got a domestic job where I could not leave work. I was a sleep-in helper.”
“I defaulted for 3 months because it was the festive season and I was drinking and partying without knowing that I was already pregnant.”
Theme 3: HIV-related stigma
“I did not want to get caught taking the pills because of stigma.”
“I was scared to tell my mother about my status and she was always there when it was time to take the medications.”
Theme 4: Health system factors
“I defaulted because I was not educated about adherence. I did not know that I must take the treatment after I became pregnant.”
“I defaulted because the nurse did not write down the TCA (to come again) date.”