Evaluation of Adherence to Nevirapine for Prevention of Mother-to-Child Transmission amongst Infants of HIV Positive Mothers in the First 6 Weeks of Life in Lagos Nigeria

Abstract

Background: Over 90% of infection in children is acquired through mother to child transmission (MTCT). Nevirapine’s efficacy, safety and affordable cost make it the most preferred non-nucleoside reverse transcriptase inhibitor (NNRTI) for paediatric prophylactic use in resource limited settings. There are very few studies on pediatric adherence to antiretroviral prophylaxis, especially in very young infants. The objective of the study was to evaluate the adherence to nevirapine for prevention of mother to child transmission (PMTCT) amongst infants of HIV positive mothers in the first 6 weeks of life. Methods: This was a questionnaire based prospective cross-sectional multicenter study initiated in July 2015 and concluded in December 2017. The study was carried out at the Aids Prevention in Nigeria (APIN/HIV) human immunodeficiency paediatric clinics of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos State, 68 Nigerian Army Reference Hospital Yaba (68NARHY) Lagos, Nigeria and the Holy Family Catholic Hospital, Festac Town, Amuwo Odofin, Lagos State. Nevirapine adherence, in infants of 0 - 6 weeks was measured by maternal verbal reports. Results: Eighty-one (81) infants receiving nevirapine within the age of 0 - 6 weeks completed the study. Majority of the infants started treatment at birth (32%) and after 4 weeks (31%). 54% of the 81 respondents do not miss or skip their doses while 46% of respondents skip doses. Majority of the respondents 18 (49%) missed their doses for 24 - 48 hours while 25% missed their doses because they were away from home and 23% ran out of pills. 85.2% took ≥95% of the prescribed medications (good or high adherence ), 8.2% took 80% - 95% of doses (moderate adherence) while 6.2% took <80% of prescribed medicines (low Adherence). The reasons for missed doses were significantly associated with the adherence levels (p < 0.05). Gender, age of child and mother, level of education and occupation of the mothers did not significantly affect the level of adherence. (p > 0.05). Conclusions: The adherence rates found in this study are comparable to other studies in developing countries. But these rates are still low for good clinical outcomes. Different levels of adherence were documented with the majority having good or high adherence. Not all of the infants started treatment at birth and Institutional delivery should be encouraged to improve early initiation of prophylaxis. The finding of patients with low adherence rates among the study population calls for intensification of counselling on adherence and should continue to be an integral part of prevention of mother to child transmission. Improved access to antiretroviral agents and improved care delivery systems are important.