Int J Biol Med Res.

2025; 16(1): 7952-7955

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Case Report

Level of Adherence to Option B+ Antiretroviral Therapy Among HIV Positive Pregnant Women Attending Antenatal
Clinics at Tertiary Health Institutions in Anambra State, Nigeria

Silas Esther A1, Clementina U. Nwankwo1, Chika Chioma H. Odira1, ObionwuOgochukwuT2

1
Department of Nursing Science, Faculty of Health Sciences & Technology, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria.
2
Medical Centre, college of Health sciences, NnamdiAzikiwe University, Nnewi Campus, Anambra State, Nigeria.

ARTICLEINFO ABSTRACT

Keywords: Aim: This study ascertained level of adherence to option B+ antiretroviral therapy (B+ ART) among HIV
Adherence, positive pregnant women attending antenatal clinics at tertiary health institutions in Anambra state and
HIV, reason(s) for non-adherence. Materials and methods: A cross-sectional descriptive design was adopted in
Positive, conducting the study among HIV positive pregnant women attending antenatal clinics at tertiary health
Pregnant, institutions in Anambra state. Purposive and convenience sampling techniques were used to select sample
Women. size of one hundred and forty-six (146) HIV positive pregnant women by Adult AIDS Clinical Trial Group
(AACTG) standardized questionnaire was used in data collectionwhich were analysed with IBM SPSS software
database (version 25). Results: Results revealed that 89% of the HIV positive pregnant women adhered to
Option B+ ART while 11% of the women were not adherent to their antiretroviral drugs. Conclusion: From
the study, the level of adherence to Option B+ ART among HIV positive pregnant women attending the tertiary
health institutions in Anambra state is good but there is still need for improvement to reach the peak which
is 100% adherence so as to totally eliminate mother to child transmission of HIV. Recommendations: Nurses
and mentor mothers in the health care facilities should intensify health education on adherence to ART.

© Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685.

Introduction To address the International Human Immunodeficiency Virus epidemic,

the World Health Organization developed three drug treatment
HIV is a deadly virus that attacks and weakens the immune system of regimens between 2010 and 2012 specifically for HIV positive pregnant
human beings making the affected individual susceptible to infection. women and their infants. World Health Organization (WHO) developed
Since the beginning of the epidemic, 85.6 million people have been the regimens calling them Option A, Option B and Option B+, to reduce
infected with the HIV virus and about 40.4 million people have died or prevent mother to child transmission of HIV. Each option comprises
of HIV [1].Globally, 39.0 million people were living with HIV at the end of different types and schedules of antiretroviral medications [4].
of 2022 and an estimated 0.7% of adults aged 15–49 years worldwide WithOption B+ all HIV-infected pregnant and breastfeeding women are
are living with HIV, although the burden of the epidemic continues to immediately initiatedon lifelong antiretroviral therapy (ART), regardless
vary considerably between countries and regions [1]. The WHO African of clinical stage or CD4+ T-cell count unlike what is obtainable in Option
Region remains most severely affected, with nearly 1 in every 25 adults A and B. Option B+ which is an improved version of both option A and
(3.2%) living with HIV and accounting for more than two-thirds of option B treatment regimen was introduced in 2012 but was adopted in
the people living with HIV worldwide [1]. In Nigeria, approximately 2 Nigeria in 2016 with full implementation reported in 2017 [5].
million adults aged 15-49 years of age are living with HIV [2] and of the
estimated 220,000 new infections in Nigeria, 37,000 were from mother- Non adherence to Antiretroviral Therapy(Option B+) by HIV positive
to-child transmission [3]. pregnant women will increase their chances of transmitting HIV to
their babies either during pregnancy, labour or delivery and if HIV is
transmitted to the baby, it will weaken the baby’s immune system
resulting to increased susceptibility to infection and failure to thrive
afterwards [6].
Corresponding author:
A descriptive cross-sectional survey done by Oginni, Aremu,
Silas Esther A Olowokere, Ayamolowo and Komolafe [7]on HIV positive pregnant
Department of Nursing Science, women in Ibadan, Nigeria revealed poor level of adherence as only 47%
Faculty of Health Sciences & Technology, of the women adhered to their drug regimen. Also, Omonaiyeet al.[5] in
NnamdiAzikiwe University, their study on adherence to ART in AkwaIbom State in the South- South
Nnewi Campus, Anambra State, Nigeria. region of Nigeria also recorded poor adherence (32.7%).
Email: [email protected]
The researcher discovered that the studies on adherence to ART
done in Nigeria showed poor adherence (as shown above) while those
conducted outside Nigeria revealed good adherence therefore this study
was borne out of curiosity to determine level of adherence to Option B+
© Copyright 2023 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685. ART among HIV positive pregnant women attending antenatal clinics at
 Silas Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955
7953

tertiary health institutions in Anambra State, Nigeria and reason(s) The study population was 230 HIV positive pregnant women who
for non-adherence.The general purpose of this study was to ascertain attend antenatal clinics at tertiary health institutions in Anambra state
the level of adherence to Option B+ ART among HIV positive pregnant for one year. The sample size for the study is 146 which was calculated
women attending antenatal clinics at tertiary health institutions with Yaro Yamane formula. Convenient and purposive sampling
Anambra State, Nigeria and to determine reason(s) for non-adherence. techniques were used in the selection of the participants. The instrument
for data collection was Adult AIDS Clinical Trial Group (AACTG)
MATERIALS AND METHODS standardized questionnairewhich was validated by a statistician and an
expert in maternal and child health Nursing. A total of 146 copies of the
Cross-sectional descriptive survey design was utilized in the study questionnaire were distributed and were all retrieved. Consent of the
to determine the level of adherence to option B+ antiretroviral therapy respondents was sought, confidentiality of information supplied by the
among HIV positive pregnant women attending antenatal clinics at respondents during and after the procedure was ensured and anonymity
tertiary health institutions in Anambra state. This study was conducted was also ensured by their names not appearing on the questionnaire.
in the tertiary health institutions in Anambra State, Nigeria. There Also, ethical approval was obtained from the ethical committees of the
are two tertiary health institutions in Anambra State, Nigeria which tertiary health institutions (NAUTH and COOUTH). Data were analysed
include NnamdiAzikiwe University Teaching Hospital (NAUTH), Nnewi using IBM SPSS software database (version 25). Tables were used to
and ChukwuemekaOdimegwuOjukwu University Teaching Hospital present date.
(COOUTH), Awka.

TABLE 1.1: Summary of Socio-demographic Characteristics of the Women (n=146)

Characteristics Frequency Percentage

1 Age 15 – 25 33 22.6
26 – 35 70 47.9
36 - 45 41 28.2
Above 45 2 1.4
2 Religion Christian 141 96.6
Islam 2 1.4
Traditional 3 2.1
3 Marital status Married 121 82.9
Divorced 4 2.7
Widowed 9 6.2
Single 12 8.2
4 Occupation Formal sector 34 23.2
Informal sector 56 38.4
Unemployed 56 38.4
5 Ethnicity Hausa 11 7.5

Igbo 131 89.7

Yoruba 2 1.4
Others 2 1.4
6 Highest level of Education No formal education 13 8.9
Primary education 14 9.6
Secondary education 94 64.4
Tertiary education 25 17.1
7 . Income of per month(in ₦) Less than 50,000 138 94.5
Above 50,000 8 5.5
8 Income of Spouse per Less than 50,000 107 73.3
month(in ₦)
Above 50,000 27 18.5
Unknown 12 8.2
9 Parity Less than 4 119 81.5
4 and above 27 18.5
10 CD4 Count <350 26 17.8

(b) >350 68 46.6

Unknown 52 35.6
 Silas Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955
7954

Table 1.1 showed that majority of the women 101(67.8%) were in the Table 1.3: Reasons for Missing ART Dose in the Past n=33
age range of 26-35 years, followed by 41(27.5%) within the age range
of 15-25 years then 6(4.0%) in the age range of 36-45 years and finally
Reasons for missing ART dose in the Yes (%) No (%)
1(0.7%) in the age range of 46-55 years. Also, majority of the women
past
145(97.3%) were Christians, 1(0.7%) was a traditionalist, 1(0.7%) of
(multiple responses) n = 33
the respondents was a muslim and 2(1.3%) fell under ‘others’ (atheists).
Majority of the respondents were married (148(99.3%) and 1(0.7%)
was divorced. 73(49.0%) of the women were into business, 44(29.5%) Simply forgot 12(36.4) 21(63.6)
were professionals while 32(21.5%) are unemployed. 144(96.6%) of
the women were Ibos, 2(1.3%) followed by those from other ethnic Away from home 11(33.3) 22(66.7)
groups (2(1.3%) while 1(0.7%) of the respondents were Hausas.
99(66.4%) of the women had tertiary education, 45(30.2%) stopped
Busy with other things 5(15.2) 28(84.8)
at secondary school while 5(3.4%) of the respondents had no formal
education. 72(48.3%) of the respondents had a child less than five years, Had a change in daily routine 1(3.0) 32(97.0)
43(28.9%) had two children less than five years, 21(14.1%) had three
children below five years while 13(8.7%) had four children less than
Fell asleep/slept through dose 2(6.0) 31(94.0)
five years of age.

Research Question 1: What is the level of adherence of the HIV Had problems taking drugs at specific 1(3.0) 32(97.0)
positive pregnant women to option B+ ART? times
Felt ill or sick 4(12.1) 29(87.9)
Table 1.2: The self-reported Adherence of the HIV Positive Pregnant
Women to Option B+ ART n=146 Wanted to avoid side effects 3(9.0) 30(91.0)

Adherence to option B+ n (%) Percentage (%) Felt depressed/overwhelmed 1(3.0) 32(97.0)

ART
Had too many pills to take 1(3.0) 32(97.0)
Adherent 130 89.0
Did not want others to notice me taking 2(6.0) 31(94.0)
Non-adherent 16 11.0 drugs

Total 146 100.0 Felt drug was toxic 3(9.0) 30(91.0)

Have you skipped taking pills before? The above are the reasons for missing Option B+ ART by the sixteen
women that missed their medication in the last four days. Major reason by
No 113 77.4 the women was forgetfulness 12(36.4), followed by being away from home
11(33.3%), busyness 5(15.2), illness 1(12.1%), feeling that drug is toxic
Yes 33 22.6 3(9%), side effects 3(9%), change in daily routine 1(3%), issue taking
drugs 1(3%), depression 1(3%), too many pills to take 1(3%).

Total 146 100.0 DISCUSSIONS

Research Question 1: What is the level of adherence of the HIV positive

When last did you skip a pill? n=33 pregnant women to option B+ ART?

Within last four days 10 30.3 It was discovered from the study that 130(89%) of the HIV positive
pregnant women adhered to option b+ ART while 16(11%) of the women
were not adherent to their drugs. A respondent is considered adherent if
Yesterday 3 9.1 she has not missed taking any doses over a 4-day period prior day of survey.
Missing at least one dose over the 4 days’ period prior day of survey is
Day before yesterday 3 9.1 considered as non-adherent. This entails that majority of the HIV positive
pregnant women that participated in this study showed good adherence
to Option B+ ART. This revealed that majority of the HIV positive pregnant
Last weekend (Saturday 4 12.1 women that participated in this study showed good adherence to Option
and/or Sunday) B+ ART. This is likely due to the effort of the mentor mothers and nurses
Within last two weeks 12 36.4 in counselling the women on the need for adherence to their medications.

Within last four weeks 1 3.0 This finding is line with the findings of Ebuyet al. [8] In their study,
they determined the level of adherence to Option B+ PMTCT drugs and
factors associated with adherence among HIV positive pregnant women
Total 33 100.0 in public hospitals of Northern Ethiopia. From their findings, 87.1% of
their respondents were adherent to Option B+ ART which they described
as reasonably good. Also, Mukoshaet al.[9] in their study in Lusaka
Table 1.2 shows that130(89%) HIV positive pregnant women that were
Zambia discovered that 81.7% of their respondents were adherent to
part of the study are adherent to Option B+ ART while 16(11%) of the
their medication (ART).However, the findings contrast that of Oginniet
women are not. 33 (22.6%) have skipped their drugs before while al.[7] which showed that only 47% of the respondents adhered to their
113(77.4%) have not skipped their drugs before. Out of the 33 that drug regimen and that of Omonaiye, et al.[5] which pointed out that only
have skipped their drugs before, 10 skipped it within the last four days, 32.7% of the HIV positive women that took part in the study self-reported
3 skipped yesterday, 3 skipped a day before, 4 skipped last weekend, 12 to have taken all ART doses in the past 96 hours following the study.The
skipped within last 2 weeks and only one skipped within last four weeks disparity in findings might be due to different level of efforts that was
made in counselling and creating awareness on the need for adherence by
as at the time the questionnaires were administered.
the nurses and mentor mothers at different health facilities.
 las Esther A Int J Biol Med Res. 2025; 16(1): 7952-7955
7955

Reasons for non-adherence of the HIV positive pregnant [3] United Nations Programme on HIV and AIDS, UNAIDS. Ending the
AIDS Epidemic, Fact Sheet [online]. 2018 (cited 2021 July) Available
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their drugs intentionally. Also being busy can make the women forget
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people living with HIV/AIDS in Hara town and its surroundings, North adherence of antiretroviral therapy among pregnant women with
Eastern Ethiopia. Their findings showed that participants who had never HIV. International Journal of Infectious Diseases. 2019; 81: 225-230.
encountered drug side effects were 2.69 times more likely to adhere to their
ART medication than those who had ever encountered drug side effect. In [6] Pietrangelo, A. What You Should Know about HIV in Children
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enhancing the adherence to PMTCT Option B+ care.
[7] Oginni, M.O., Aremu, O.O., Olowokere, A.E., Ayamolowo, S.J. and
Also Nthala, et al.[12] in their study discovered that adherence to ART Komolafe, A.O. Adherence to HIV Care among HIV Positive Pregnant
was a challenge (low) that needed to be addressed and reasons for that Women in Nigeria. African Journal of Midwifery and Women’s Health
included economic factors (lack of food), physical factors (side effects of 2018; 12(1), 28-34.
the drugs), environmental factors (long waiting hours with long queues)
and community factors (social stigma). Still in line with the above findings, [8] Ebuy, H., Yebyo, H. and Alemayehu, M. Level of Adherence and
Obonyo [13] from her findings opined that fear of discrimination and Predictors of Adherence to the Option B+ PMTCT Programme in
stigma (69.9%) also affected adherence to ART. Ebuyet al.[8]in their Tigray, Northern Ethiopia. International Journal of Infectious Diseases
cross-sectional study identified that among the challenges for adherence 2015; 33: 123-129
to Option B+ PMTCT, forgetting to take the medications (92.3%) was the
dominant obstacle, followed by the fear of side effects (38.5%). [9] Mukosha, M., Chiyesu, G. and Vwalka, B. Adherence to Option B+
Among Pregnant Women Attending Antenatal Clinic at Chilenje
On the contrary, the study carried out by Chukwukaodinaka [14] in Level One Hospital Lusaka, Zambia. Pan African Medical Journal
FCT, Abuja, Nigeria, revealed that PMTCT services were hindered by the 2019;35(49).
following: permission from spouse before being tested, couple counselling
not done, group posttest counselling, non-incorporation of family [10]Tesfaye A.L and MeleseA.R. Adherence to antiretroviral therapy and
planning and low support group enrolment. The different reasons for non- associated factors among people living with HIV/AIDS in Hara town
adherence to ART might likely be due to the options in the questionnaire. It and its surroundings, North Eastern Ethiopia: A Cross-Sectional
can also be due to different individuals that participated in and conducted Study. Ethiopian Journal of Health Sciences2019;29(2):299-308
the studies.
[11]11. Wondimu, F., Yetwale, F., Admassu E., Binu, W., AbdissaBulto,
Conclusion G., Lake, G., Girmaye, E., Temesgen, K. andMarama, G. Adherence to
Option B+ Care for the Prevention of Mother-to-Child Transmission
The level of adherence to Option B+ ART among HIV positive pregnant among Pregnant Women in Ethiopia. HIV/AIDS - Research and
women attending the tertiary health institutions in Anambra state is good Palliative Care 2020; 12: 769–778.
but there is still need for improvement to reach the peak which is 100%
adherence so as to totally eliminate mother to child transmission of HIV. [12]Nthala, V., Makasa, M., Hazeemba, A., and Sitali, D. Adherence to
antiretroviral therapy among HIV positive pregnant women in Lusaka
Acknowledgements – No acknowledgements district of Zambia. Journal of Public Health International, 2018;1(3).

Declaration of interest: The authors declare there is no conflict of [13]Obonyo, F.F.A. Non Adherence to PMTCT Treatment and Loss to
interest of any form with regards to this study Follow Up of Hiv Positive Mothers and Babies In Mombasa County,
Kenya. Unpublished master’s thesis.Kenya: School Of Public Health,
Funding sources: There was no external source of funding received for Kenyatta University; 2016.
this study from any funding institutions or donor with regards to this
study. [14]Chukwuodinaka, E.C (. Factors Influencing the Utilisation of PMTCT
Services in the Federal Capital Territory of Nigeria. Unpublished
master’s thesis. South Africa: University of South Africa; 2014.
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