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. 2022 Oct;27(10):902-912.
doi: 10.1111/tmi.13816. Epub 2022 Sep 20.

Factors associated with antiretroviral therapy use among pregnant women in rural and urban settings in Southern Province, Zambia: 2016-2019

Juliet A Morales  1 , Mutinta Hamahuwa  2 , Nkumbula Moyo  2 , Jane N Mutanga  3 , Jessica L Schue  1 , Sylvia Maunga  2 , Philip E Thuma  2   4 , William J Moss  5 , Catherine G Sutcliffe  5
Affiliations

Factors associated with antiretroviral therapy use among pregnant women in rural and urban settings in Southern Province, Zambia: 2016-2019

Juliet A Morales et al. Trop Med Int Health. 2022 Oct.

Abstract

Objectives: To assess antiretroviral therapy (ART) coverage among pregnant women living with HIV and compare the characteristics of women who received and did not receive ART during pregnancy in Zambia.

Methods: A cross-sectional study was conducted at urban and rural health facilities in Southern Province, Zambia, from 2016 to 2019. Pregnant women living with HIV delivering at study sites were enrolled and administered a questionnaire, and the results of infant diagnostic testing for HIV at birth was documented.

Results: About 1184 mother/infant pairs were enrolled. ART coverage was 93.7%. Most women who did not receive ART during pregnancy reported HIV diagnosis at delivery (18.0%) or during pregnancy (57.7%). The primary reported reason for not receiving ART was not wanting to take the drugs. Women who did not receive ART during pregnancy were significantly younger, less likely to have disclosed their HIV-infection status to others, and less likely to have received antenatal care than women who received ART. ART use correlated with higher levels of education in urban but not rural sites. Overall, 1.0% of infants were infected with HIV at birth, including 0.8% of infants born to women who received ART and 4.1% of infants born to women who did not.

Conclusions: Most women received ART according to guidelines, resulting in low perinatal transmission rates of HIV to infants. Efforts to increase ART coverage and prevent vertical transmission should focus on identifying incident HIV infections during pregnancy and strengthening counselling for newly diagnosed pregnant women.

Keywords: HIV; paediatrics; prevention of mother-to-child HIV transmission; sub-Saharan Africa.

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Figures

Figure 1:
Figure 1:. Study overview and procedures
Figure 2:
Figure 2:. Enrollment flowchart by site
ART: antiretroviral therapy
Figure 3:
Figure 3:. Mother-to-child transmission of HIV by maternal receipt of antiretroviral therapy, overall and by site
ART: antiretroviral therapy
Figure 4:
Figure 4:. Self-reported reasons for not receiving antiretroviral therapy during pregnancy among women diagnosed with HIV before or during pregnancy
Note: 27 women diagnosed with HIV before pregnancy and 64 diagnosed during pregnancy provided reasons for not receiving antiretroviral therapy during pregnancy. Data labels represent % (N).
See this image and copyright information in PMC

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