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Meta-Analysis
. 2024 Jan 5;24(1):94.
doi: 10.1186/s12889-023-17004-9.

Adherence to option B + antiretroviral therapy and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa: a systematic review and meta-analysis

Lucresse Corine Fassinou  1   2 , Diane Songwa Nkeunang  3 , Thérèse Delvaux  4 , Nicolas Nagot  5 , Fati Kirakoya-Samadoulougou  3
Affiliations
Meta-Analysis

Adherence to option B + antiretroviral therapy and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa: a systematic review and meta-analysis

Lucresse Corine Fassinou et al. BMC Public Health. .

Abstract

Background: To assess the adherence to option B + antiretroviral therapy (ART) and associated factors in pregnant and breastfeeding women in Sub-Saharan Africa (SSA).

Methods: We conducted a comprehensive search from 01st January 2012 to 03rd October 2022, across four databases: PubMed, Scopus, Proquest Central, and Index Medicus Africain, to identify studies focused on pregnant and/or breastfeeding women living with HIV and receiving option B+ ART in SSA. Studies reporting adherence data were included in the meta-analysis. Were excluded studies published before 01st January 2012, grey literature, systematic reviews, and meta-analysis studies. Articles selection and data extraction were performed independently by two reviewers. We evaluated pooled adherence and pooled association between various factors and adherence using a random-effects model.

Results: Overall, 42 studies involving 15,158 participants across 15 countries contributed to the meta-analysis. The overall pooled adherence was 72.3% (95% CI: 68.2-76.1%). Having high education level (pooled odds ratio (OR): 2.25; 95% CI: 1.57-3.21), living in urban area (pooled OR: 1.75; 95% CI: 1.10-2.81), disclosing status to a family/partner (pooled OR: 1.74; 95% CI: 1.27-2.40), having a support system (pooled OR: 3.19; 95% CI: 1.89-5.36), receiving counseling (pooled OR: 3.97; 95% CI: 2.96-5.34), initiating ART at early clinical HIV stage (pooled OR: 2.22; 95% CI: 1.08-4.56), and having good knowledge on PMTCT/HIV (pooled OR: 2.71; 95% CI: 1.40-5.25) were factors significantly associated with adherence to option B + ART.

Conclusions: Despite the implementation of option B+ ART, the level of adherence among pregnant and breastfeeding women in SSA falls short of meeting the critical thresholds for viral load suppression as outlined in the 95-95-95 objectives set for 2025. These objectives are integral for achieving HIV elimination, and in turn, preventing HIV mother-to-child transmission. To bridge this gap, urgent tailored interventions based on individual and structural factors are essential to enhance adherence within these subgroups of women. This targeted approach is crucial in striving towards the HIV elimination target in SSA.

Keywords: Adherence; Antiretroviral therapy; Breastfeeding; Option B +; Pregnancy; Sub-Saharan Africa.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of studies included in the systematic review and meta-analysis of adherence to option B + ART among pregnant and/or breastfeeding women in SSA
Fig. 2
Fig. 2
Pooled proportion of pregnant and/or breastfeeding women adhering to option B + ART in SSA
Fig. 3
Fig. 3
Funnel plot of the pooled adherence to option B + ART in pregnant and/or breastfeeding women in SSA
Fig. 4
Fig. 4
Forest plot of the association between age (a), occupation (b), educational level (c), and adherence to option B + ART
Fig. 5
Fig. 5
Forest plot of the association between area of residence (a), marital status (b), and adherence to option B + ART
Fig. 6
Fig. 6
Forest Plot showing association between disclosure status (a), WHO clinical stage (b), support of anyone or involvement from a partner (c), and adherence to option B + ART in pregnant or breastfeeding women in SSA
Fig. 7
Fig. 7
Forest Plot reporting association between receiving counseling (a), knowledge on PMTCT/HIV (b), and adherence to option B + ART in pregnant or breastfeeding women in SSA
See this image and copyright information in PMC

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