Determinants of Art Initiation and Perceptions On Antiretroviral Drugs Uptake During Pregnancy and Puerperium at Homa Bay County Referral Hospital In Homa Bay, Kenya

Abstract

Use of effective antiretroviral therapy (ART) in Human Immunodeficiency Virus (HIV) positive pregnant women has been proven to be the most effective technique of preventing mother-to-child transmission (PMTCT) of HIV. This strategy has been shown to drastically reduce the incidence of HIV in newborns. It is however noteworthy that this service has not achieved its full potential in terms of utilization in most counties in Kenya as the rates of maternal HIV transmission remains high with the national average at 6.2%. Some of the determinants of ART initiation and perceptions on its use for PMTCT are not fully understood. The objective of the study was to outline the determinants of the timing of initiation and perceptions on uptake of ART by HIV positive pregnant women on PMTCT in Homa Bay County, Kenya. The perceptions of healthcare workers were also determined. Specifically, the study sought to determine the perceptions of HIV positive pregnant women and healthcare workers on the use and barriers to ART for PMTCT services. The study also assessed antenatal attendance for PMTCT and timing of ART initiation. A cross-sectional study design was used and study conducted at Homa Bay County Referral Hospital (HCRF). The study targeted expectant HIV positive women who presented ante-natal, during labor and post-partum at HCRH during clinic. A sample size of 290 HIV positive women as determined by Fisher et al., (1998) formula was used. Data on study participants‟ socio-demographic status, awareness and perceptions on PMTCT services, antenatal clinic attendance, timing of ART initiation and the proximity to PMTCT services was collected using a pretested interviewer administered questionnaire. Healthcare workers running PMTCT clinics were also interviewed on their experience and barriers to PMTCT services as may have been reported to them by the women. Socio-demographic characteristics of the respondents was expressed using descriptive statistics. The number and timing of antenatal attendance was expressed in percentages. The timing of initiation of ART was expressed in frequencies and percentages and chi square test used to determine the association between income and level of education and the timing of ART initiation. Perceptions on barriers to PMTCT were weighted and expressed in percentages. The timing of Antenatal attendance was categorized and chi square used to compare the time of ANC initiation and the likelihood of facility delivery. The participants‟ views on the possible things to be improved were coded into thematic areas. The level of training of the PMTCT providers and their views on barriers to PMTCT was expressed in frequency and percentages. Most women‟s perception on barriers to PMTCT included stigma at 45%, lack of spouse support (23%), lack of knowledge (15%), distance (12%). The women expressed knowledge about PMTCT with 86.6% of them having heard about the services. Other than use of PMTCT for prevention of infections, only 67.2% cited safe delivery as a preventive strategy. 22% of them thought that not breastfeeding would confer additional benefits while safe sexual practices was only mentioned by 18.6 % of the respondents. In the timing of initiation of ART for PMTCT, 55.1% of the respondents started it before being pregnant. This included a small subset (7.2%) of women who were themselves survivors of vertically transmitted infection and had now reached child bearing age. Antenatal visit attendance for PMTCT was mostly initiated late after 3 months into pregnancy by 53.6 % of the respondents. Total attendance of ANC across the continuum of pregnancy was high with 92.4 % of the respondents reporting to have attended at least once. All the respondents indicated having attended ANC at least once. Rate of institutional deliveries was however at 87.4%. Occupation(p=0.011), level of education (p=0.000) and level of income (p=0.015) were positively associated with the decision to deliver at home or in the health facility. Health care workers expressed lack of laboratory support, drugs stock outs and clients‟ refusal to take medication as the challenges they encountered. In addition, they cited stigma, lack of spouse support and attitude of health care workers as some of the barriers women reported to them as they sought PMTCT services