Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda

Caroline Kambugu Nabasirye; Ratib Mawa; Elizabeth Ayebare

doi:doi:10.11648/j.ijhpebs.20190501.15

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Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda

Caroline Kambugu Nabasirye, Ratib Mawa, Elizabeth Ayebare

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 5, Issue 1)

Received: 14 February 2019 Accepted: 3 April 2019 Published: 6 May 2019

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Abstract

To eliminate mother to child transmission of HIV, existing interventions might need to be scaled-up and rigorously implemented. One of the strategies to reduce vertical transmission of HIVis the 4-6weeks daily single oral dose ofNevirapine (NVP) or Zidovidinerecommended for newbornsto HIV positive mothers. Maternal optimal adherence to these anti-retroviral prophylaxis regimens is imperative to prevention of vertical transmission of HIV. Limited studies investigated maternal adherence to infant’s NVP prophylaxis regimen and associated factors. This study examined the level and factors influencing maternal adherence to infant’s NVPprophylaxis regimenat six weeks of age. Maternal adherence to infant’s NVP regimen was defined as dispensation of 95% of the total daily single dose of NVPsuspension to infants at 6 weeks of age. Maternal adherence, socio-demographic and psychosocial factors were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the level and factors influencing maternal adherence to infant’s NVP regimen respectively. Results showed that 77% of the mothers had optimal adherence. Maternal age ≥ 20 years and believe in the effectiveness of NVP in prevention of vertical transmission of HIV were associated with increased likelihood of adherence to infants NVP regimen (OR 6.18; 95% CI: 1.64-23.24) and (OR 12.69; 95% CI 3.07-52.44) respectively.In conclusion maternal maturity and perceived benefits of NVP seems to be important positive drivers of optimal adherence. This suggests the importance of considering psychosocial and demographic characteristics of mothers in policy and intervention designing.

Published in	International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 5, Issue 1)
DOI	10.11648/j.ijhpebs.20190501.15
Page(s)	37-46
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Adherence, Prophylaxis, Postpartum Period, Mothers

References

[1]	UNAIDS, Global HIV & AIDS statistics - 2018 fact sheet. 2018, UNAIDS: Geneva, Switzerland.
[2]	WHO. HIV Data and statistics 2018 [cited 2018 18/8/2018]; Available from: http://www.who.int/hiv/data/en/.
[3]	Uganda, A., Commission (UAC): HIV and AIDS Uganda Country Progress Report, 2013. Kampala: UAC; 2014. 2016.
[4]	Vrazo, A.C., D. Sullivan, and B.R. Phelps, Eliminating mother-to-child transmission of HIV by 2030: 5 strategies to ensure continued progress. Global Health: Science and Practice, 2018. 6(2): p. 249-256.
[5]	WHO. Mother -to- child transmission of HIV. 2018 [cited 2018 18/8/2018]; Available from: http://www.who.int/hiv/topics/mtct/about/en/.
[6]	Coovadia, H.M., et al., Efficacy and safety of an extended nevirapine regimen in infant children of breastfeeding mothers with HIV-1 infection for prevention of postnatal HIV-1 transmission (HPTN 046): a randomised, double-blind, placebo-controlled trial. The Lancet, 2012. 379(9812): p. 221-228.
[7]	Vreeman, R.C., et al., A systematic review of pediatric adherence to antiretroviral therapy in low-and middle-income countries. The Pediatric infectious disease journal, 2008. 27(8): p. 686-691.
[8]	Flynn, P.M., et al., Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE) A Randomized, Open-Label, Clinical Trial. JAIDS Journal of Acquired Immune Deficiency Syndromes, 2018. 77(4): p. 383-392.
[9]	UPdaTE, P.J.W., Geneva, April, Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. 2012.
[10]	Organization, W.H., Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2016: World Health Organization.
[11]	Osterberg, L. and T. Blaschke, Adherence to medication. New England Journal of Medicine, 2005. 353(5): p. 487-497.
[12]	Desmond, C. and J. Gow, Impacts and interventions: The HIV/AIDS epidemic and the children of South Africa. 2015: University of Natal Press.
[13]	MOH, CONSOLIDATED GUIDELINES FOR PREVENTION AND TREATMENT OF HIV IN UGANDA 2016.
[14]	Uganda, M.o.H., Uganda Clinical Guideline 2016. 2016.
[15]	Hodgson, I., et al., A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. 2014. 9(11): p. e111421.
[16]	Decker, S., et al., Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda. 2017. 12(6): p. e0179448.
[17]	Haji, H.J.I.J.o.I.D., Factors associated with poor adherence to ant-retroviral therapy among HIV/AIDS patients attending care and treatment clinic at Mnazi Mmoja Hospital, Zanzibar. 2018. 73: p. 250-251.
[18]	Cook, R., et al., A Bayesian Analysis of Prenatal Maternal Factors Predicting Nonadherence to Infant HIV Medication in South Africa. 2018: p. 1-9.
[19]	Yee, L.M., et al., Relationship between intimate partner violence and antiretroviral adherence and viral suppression in pregnancy. Sexual & Reproductive Healthcare, 2018. 17: p. 7-11.
[20]	Ford, C., et al., Women's decision-making and uptake of services to prevent mother-to-child HIV transmission in Zambia. 2018. 30(4): p. 426-434.
[21]	Ford, C.E., et al., Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis. 2018: p. 1-9.
[22]	Landefeld, C., et al., Prevention of Mother-to-Child Transmission of HIV in Yaounde: Barrier to Care. 2018. 30(1): p. 116-120.
[23]	Taylor, S.E., H. Friedman, and R. Silver, Social support. Foundations of health psychology, 2007: p. 145-171.
[24]	Ambia, J. and J.J.J.o.t.I.A.S. Mandala, A systematic review of interventions to improve prevention of mother‐to‐child HIV transmission service delivery and promote retention. 2016. 19(1): p. 20309.
[25]	Musenjeri, S.K., Factors affecting adherence to treatment in HIV exposed infants in Mumias region, Western Kenya. 2016, COHES, JKUAT.
[26]	Berghoff, C.R., et al., The Role of Emotional Avoidance, the Patient–Provider Relationship, and Other Social Support in ART Adherence for HIV+ Individuals. AIDS and Behavior, 2018. 22(3): p. 929-938.
[27]	Dunbar-Jacob, J., E. Schlenk, and M. McCall, Handbook of health psychology. 2001, Mahwah: Erlbaum.
[28]	DiMatteo, M.R., Social support and patient adherence to medical treatment: a meta-analysis. 2004, American Psychological Association.
[29]	Haberer, J.E., et al., Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. PloS one, 2012. 7(5): p. e36737.
[30]	Olds, P.K., et al., Assessment of HIV antiretroviral therapy adherence by measuring drug concentrations in hair among children in rural Uganda. AIDS care, 2015. 27(3): p. 327-332.
[31]	Karcher, H., et al., Outcome of Different Nevirapine Administration Strategies in Preventin g Mother-to-Child Transmission (PMTCT) Programs in Tanzania and Uganda. Journal of the International AIDS Society, 2006. 8(2): p. 12.
[32]	Buregyeya, E., et al., Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC pregnancy and childbirth, 2017. 17(1): p. 94.
[33]	UNAIDS, Uganda Global AIDS Response Report 2014. 2015.
[34]	MJAP, fast tracking towards 90:90:90 Makerere University Joint AIDS Programme, Annual report 2015. 2015.
[35]	National AIDS Control Organisation, Pediatric Antiretroviral Therapy (ART) Guidelines. 2013.
[36]	Berger, B.E., C.E. Ferrans, and F.R. Lashley, Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale¶. Research in nursing & health, 2001. 24(6): p. 518-529.
[37]	Sarason, I.G., et al., A brief measure of social support: Practical and theoretical implications. Journal of social and personal relationships, 1987. 4(4): p. 497-510.
[38]	Okawa, S., et al., Longitudinal adherence to antiretroviral drugs for preventing mother-to-child transmission of HIV in Zambia. BMC pregnancy and childbirth, 2015. 15(1): p. 258.
[39]	Ngabirano, T., et al., Psychosocial Adaptation and ART Adherence of HIV-infected Adults at an Urban Ambulatory Clinic in Uganda. J Psychol Psychother, 2016. 6(236): p. 2161-0487.10002.
[40]	Nachega, J.B., et al., Association of antiretroviral therapy adherence and health care costs. Annals of internal medicine, 2010. 152(1): p. 18-25.
[41]	Srof, B.J. and B. Velsor-Friedrich, Health promotion in adolescents: A review of Pender’s health promotion model. Nursing Science Quarterly, 2006. 19(4): p. 366-373.
[42]	Ekama, S., et al., Pattern and determinants of antiretroviral drug adherence among Nigerian pregnant women. Journal of pregnancy, 2012. 2012.
[43]	Holstad, M.K.M., et al., Factors associated with adherence to antiretroviral therapy. Journal of the Association of Nurses in AIDS Care, 2006. 17(2): p. 4-15.
[44]	Luszczynska, A., Y. Sarkar, and N. Knoll, Received social support, self-efficacy, and finding benefits in disease as predictors of physical functioning and adherence to antiretroviral therapy. Patient Education and Counseling, 2007. 66(1): p. 37-42.
[45]	Teferra, A.S., F.M. Alemu, and S.M. Woldeyohannes, Institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Sekela District, North West of Ethiopia: A community-based cross sectional study. BMC pregnancy and childbirth, 2012. 12(1): p. 74.
[46]	Montagu, D., et al., Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PloS one, 2011. 6(2): p. e17155.
[47]	Ware, N.C., et al., Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS medicine, 2009. 6(1): p. e1000011.
[48]	Remien, R.H., et al., Adherence to medication treatment: A qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities. AIDS and Behavior, 2003. 7(1): p. 61-72.
[49]	Vervoort, S.C., et al., Adherence in antiretroviral therapy: a review of qualitative studies. Aids, 2007. 21(3): p. 271-281.
[50]	Walcott, M.M., et al., Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study. BMC public Health, 2013. 13(1): p. 1115.

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Caroline Kambugu Nabasirye, Ratib Mawa, Elizabeth Ayebare. (2019). Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 5(1), 37-46. https://doi.org/10.11648/j.ijhpebs.20190501.15

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ACS Style

Caroline Kambugu Nabasirye; Ratib Mawa; Elizabeth Ayebare. Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2019, 5(1), 37-46. doi: 10.11648/j.ijhpebs.20190501.15

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AMA Style

Caroline Kambugu Nabasirye, Ratib Mawa, Elizabeth Ayebare. Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda. Int J HIV/AIDS Prev Educ Behav Sci. 2019;5(1):37-46. doi: 10.11648/j.ijhpebs.20190501.15

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@article{10.11648/j.ijhpebs.20190501.15,
  author = {Caroline Kambugu Nabasirye and Ratib Mawa and Elizabeth Ayebare},
  title = {Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {5},
  number = {1},
  pages = {37-46},
  doi = {10.11648/j.ijhpebs.20190501.15},
  url = {https://doi.org/10.11648/j.ijhpebs.20190501.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20190501.15},
  abstract = {To eliminate mother to child transmission of HIV, existing interventions might need to be scaled-up and rigorously implemented. One of the strategies to reduce vertical transmission of HIVis the 4-6weeks daily single oral dose ofNevirapine (NVP) or Zidovidinerecommended for newbornsto HIV positive mothers. Maternal optimal adherence to these anti-retroviral prophylaxis regimens is imperative to prevention of vertical transmission of HIV. Limited studies investigated maternal adherence to infant’s NVP prophylaxis regimen and associated factors. This study examined the level and factors influencing maternal adherence to infant’s NVPprophylaxis regimenat six weeks of age. Maternal adherence to infant’s NVP regimen was defined as dispensation of 95% of the total daily single dose of NVPsuspension to infants at 6 weeks of age. Maternal adherence, socio-demographic and psychosocial factors were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the level and factors influencing maternal adherence to infant’s NVP regimen respectively. Results showed that 77% of the mothers had optimal adherence. Maternal age ≥ 20 years and believe in the effectiveness of NVP in prevention of vertical transmission of HIV were associated with increased likelihood of adherence to infants NVP regimen (OR 6.18; 95% CI: 1.64-23.24) and (OR 12.69; 95% CI 3.07-52.44) respectively.In conclusion maternal maturity and perceived benefits of NVP seems to be important positive drivers of optimal adherence. This suggests the importance of considering psychosocial and demographic characteristics of mothers in policy and intervention designing.},
 year = {2019}
}

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TY  - JOUR
T1  - Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda
AU  - Caroline Kambugu Nabasirye
AU  - Ratib Mawa
AU  - Elizabeth Ayebare
Y1  - 2019/05/06
PY  - 2019
N1  - https://doi.org/10.11648/j.ijhpebs.20190501.15
DO  - 10.11648/j.ijhpebs.20190501.15
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 37
EP  - 46
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20190501.15
AB  - To eliminate mother to child transmission of HIV, existing interventions might need to be scaled-up and rigorously implemented. One of the strategies to reduce vertical transmission of HIVis the 4-6weeks daily single oral dose ofNevirapine (NVP) or Zidovidinerecommended for newbornsto HIV positive mothers. Maternal optimal adherence to these anti-retroviral prophylaxis regimens is imperative to prevention of vertical transmission of HIV. Limited studies investigated maternal adherence to infant’s NVP prophylaxis regimen and associated factors. This study examined the level and factors influencing maternal adherence to infant’s NVPprophylaxis regimenat six weeks of age. Maternal adherence to infant’s NVP regimen was defined as dispensation of 95% of the total daily single dose of NVPsuspension to infants at 6 weeks of age. Maternal adherence, socio-demographic and psychosocial factors were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the level and factors influencing maternal adherence to infant’s NVP regimen respectively. Results showed that 77% of the mothers had optimal adherence. Maternal age ≥ 20 years and believe in the effectiveness of NVP in prevention of vertical transmission of HIV were associated with increased likelihood of adherence to infants NVP regimen (OR 6.18; 95% CI: 1.64-23.24) and (OR 12.69; 95% CI 3.07-52.44) respectively.In conclusion maternal maturity and perceived benefits of NVP seems to be important positive drivers of optimal adherence. This suggests the importance of considering psychosocial and demographic characteristics of mothers in policy and intervention designing.
VL  - 5
IS  - 1
ER  -

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Author Information

Caroline Kambugu Nabasirye

Department of Nursing and Midwifery, Faculty of Health Sciences, Lira University, Lira, Uganda
Ratib Mawa

Department of Public Health, Faculty of Health Sciences, Victoria University, Kampala, Uganda
Elizabeth Ayebare

Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda

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Caroline Kambugu Nabasirye, Ratib Mawa, Elizabeth Ayebare. (2019). Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 5(1), 37-46. https://doi.org/10.11648/j.ijhpebs.20190501.15

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ACS Style

Caroline Kambugu Nabasirye; Ratib Mawa; Elizabeth Ayebare. Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2019, 5(1), 37-46. doi: 10.11648/j.ijhpebs.20190501.15

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AMA Style

Caroline Kambugu Nabasirye, Ratib Mawa, Elizabeth Ayebare. Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda. Int J HIV/AIDS Prev Educ Behav Sci. 2019;5(1):37-46. doi: 10.11648/j.ijhpebs.20190501.15

Copy | Download

@article{10.11648/j.ijhpebs.20190501.15,
  author = {Caroline Kambugu Nabasirye and Ratib Mawa and Elizabeth Ayebare},
  title = {Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {5},
  number = {1},
  pages = {37-46},
  doi = {10.11648/j.ijhpebs.20190501.15},
  url = {https://doi.org/10.11648/j.ijhpebs.20190501.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20190501.15},
  abstract = {To eliminate mother to child transmission of HIV, existing interventions might need to be scaled-up and rigorously implemented. One of the strategies to reduce vertical transmission of HIVis the 4-6weeks daily single oral dose ofNevirapine (NVP) or Zidovidinerecommended for newbornsto HIV positive mothers. Maternal optimal adherence to these anti-retroviral prophylaxis regimens is imperative to prevention of vertical transmission of HIV. Limited studies investigated maternal adherence to infant’s NVP prophylaxis regimen and associated factors. This study examined the level and factors influencing maternal adherence to infant’s NVPprophylaxis regimenat six weeks of age. Maternal adherence to infant’s NVP regimen was defined as dispensation of 95% of the total daily single dose of NVPsuspension to infants at 6 weeks of age. Maternal adherence, socio-demographic and psychosocial factors were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the level and factors influencing maternal adherence to infant’s NVP regimen respectively. Results showed that 77% of the mothers had optimal adherence. Maternal age ≥ 20 years and believe in the effectiveness of NVP in prevention of vertical transmission of HIV were associated with increased likelihood of adherence to infants NVP regimen (OR 6.18; 95% CI: 1.64-23.24) and (OR 12.69; 95% CI 3.07-52.44) respectively.In conclusion maternal maturity and perceived benefits of NVP seems to be important positive drivers of optimal adherence. This suggests the importance of considering psychosocial and demographic characteristics of mothers in policy and intervention designing.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Factors Influencing Maternal Adherence to Infant’s Nevirapine Prophylaxis in a Cross-Sectional Study Conducted at Mulago Hospital, Kampala, Uganda
AU  - Caroline Kambugu Nabasirye
AU  - Ratib Mawa
AU  - Elizabeth Ayebare
Y1  - 2019/05/06
PY  - 2019
N1  - https://doi.org/10.11648/j.ijhpebs.20190501.15
DO  - 10.11648/j.ijhpebs.20190501.15
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 37
EP  - 46
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20190501.15
AB  - To eliminate mother to child transmission of HIV, existing interventions might need to be scaled-up and rigorously implemented. One of the strategies to reduce vertical transmission of HIVis the 4-6weeks daily single oral dose ofNevirapine (NVP) or Zidovidinerecommended for newbornsto HIV positive mothers. Maternal optimal adherence to these anti-retroviral prophylaxis regimens is imperative to prevention of vertical transmission of HIV. Limited studies investigated maternal adherence to infant’s NVP prophylaxis regimen and associated factors. This study examined the level and factors influencing maternal adherence to infant’s NVPprophylaxis regimenat six weeks of age. Maternal adherence to infant’s NVP regimen was defined as dispensation of 95% of the total daily single dose of NVPsuspension to infants at 6 weeks of age. Maternal adherence, socio-demographic and psychosocial factors were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the level and factors influencing maternal adherence to infant’s NVP regimen respectively. Results showed that 77% of the mothers had optimal adherence. Maternal age ≥ 20 years and believe in the effectiveness of NVP in prevention of vertical transmission of HIV were associated with increased likelihood of adherence to infants NVP regimen (OR 6.18; 95% CI: 1.64-23.24) and (OR 12.69; 95% CI 3.07-52.44) respectively.In conclusion maternal maturity and perceived benefits of NVP seems to be important positive drivers of optimal adherence. This suggests the importance of considering psychosocial and demographic characteristics of mothers in policy and intervention designing.
VL  - 5
IS  - 1
ER  -

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