{
  "abstract": "Background Treatment adherence is crucial for addressing public health issues, notably HIV, affecting 39 million globally and 2 million in Nigeria. 7% of pregnant women estimated to have HIV in Nigeria. The global HIV care target is for 95% of infected individuals to know their status, access treatment, and achieve viral suppression, yet Nigeria has not met these targets. Adherence in HIV care is between treatment access and viral suppression. While over 1 million people living with HIV are accessing treatment, not all achieve viral suppression. The objective of this study was to investigate the HIV treatment adherence level among pregnant and breastfeeding women, along with associated factors, barriers, facilitators and perspectives to improve adherence.Methods This was a mixed-methods study that involved 2,008 pregnant and breastfeeding women living with HIV to assess treatment adherence objectively and subjectively and its factors. Additionally, 48 semi-structured interviews with purposively selected women (n=24) and healthcare providers (n=24) to investigate barriers, facilitators, and perspectives on improving adherence. Quantitative data was analysed using Chi-squared tests and a logistic regression test to determine factors associated with optimal adherence, while reflective thematic analysis was used for qualitative data.Results Medication refill adherence was observed to be 100% optimal, and a significant proportion (97.67%) of women taking HIV treatment reported optimal adherence, and varied across geopolitical zones, ranging from 93.52% in North-Central to 99.50% in South-West, with an overall 2.33% sub-optimal adherence reported. Among pregnant and breastfeeding women, adherence was 98.43% and 97.48%, respectively. In the logistic regression analysis, after adjusting for confounding factors, pregnant/breastfeeding women with optimal adherence had over 1,400 times higher odds of achieving viral suppression compared to those without (OR: 1466.54, 95% CI: 397–5405, p-value 0.001). Facilitators for optimal adherence included counselling, free treatment, support persons, follow-ups, home visits, positive healthcare providers’ behaviour, knowledge of treatment benefits, alarm setting, disclosure, partner/family support, and desire for HIV-free children. Reasons for suboptimal adherence included forgetfulness, pill burden, non-disclosure, lack of partner support, and fear of stigma/discrimination.Conclusion Adherence to HIV treatment was optimal, and viral suppression was significantly associated with optimal adherence. However, sub-optimal adherence and its underlying reasons remain a public health concern. Continuous counselling, free treatment access, support persons, follow-up calls, home visits, healthcare providers’ positive behaviour, knowledge of treatment benefits, setting alarms, disclosure, partner support, and desire to have HIV-free babies could improve and maintain adherence.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Celestine Effiong"
    }
  ],
  "title": "P11 Public health: HIV treatment adherence in pregnancy and during breastfeeding",
  "uid": "2032d62b-0f3b-5e4f-9f51-1a1fc895db89"
}