Acceptance of and adherence to full anti-retroviral therapy for prevention of mother to child transmission in HIV infected pregnant women with CD4 count above 350 at Nhlangano Health Centre, Swaziland.
Thesis (MFamMed)--Stellenbosch University, 2018.
ENGLISH SUMMARY : Epidemic of HIV infection is hitting Swaziland where the prevalence is among the highest in the world. Nhlangano Health Centre (NHC) in collaboration with Medecins Sans Frontiers Switzerland (MSF Switzerland) opted to hit early by starting Highly Active Anti-retroviral Therapy (HAART) among HIV infected pregnant women with CD4 count cells above 350. This new intervention raised concerns on acceptability and adherence which needed to be assessed. Study design: This was a descriptive study which explored the acceptance of and adherence of pregnant women to full anti-retroviral therapy at Nhlangano Health Centre in the period from 24th June 2014 to 23rd June 2015. The level of adherence was assessed by announced pill counts on subsequent visits. Then, 6 months after initiation, the viral load and a second CD4 count were determined. Results: 98 participants were recruited and initiated; one later died. 80.6% resided in the rural area. 80.6% attended secondary school. Majority were single (79.6%). Mean age was 25.4 years. 64.3% booked at 2nd trimester. Most were multiparous (75.5%). Mean haemoglobin was 11.1g/dl. After 6 months, mean CD4 count was 709.4 up from 554.4 (initial) and 66 (95.6%) had undetectable viral load risen from 14 (20.2%) at initiation. 69 participants (70.4%) were adherent to treatment; 3 (3.1%) of them failed to suppress completely the viral loads. 13 pregnant women refused HAART; of these 12 were interviewed and one declined. The rate of acceptance was 88.3%. Conclusion: Most of the HIV infected pregnant women who visited the clinic accepted the treatment, their CD4 count increased and had undetectable viral loads after 6 months. Anti-retroviral therapy is effective and can be successfully initiated in pregnant women with CD4 count above 350 but should be monitored closely to avoid loss to follow-up.
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