The Influence of Socio-economic Factors on Adherence to Antiretroviral Therapy (Art) among HIV-positive Pregnant Women: A Case of Chipata District, Eastern Province, Zambia

Abstract

Background: Sustained antiretroviral therapy (ART) adherence during pregnancy is important for maternal health and prevention of vertical HIV transmission. This study examined ART adherence and its socio-economic, geographic, and health-system correlates among HIV-positive pregnant women in Chipata District, Eastern Province, Zambia. Methods: A cross-sectional mixed-methods study was conducted among 300 HIV-positive pregnant women attending four health facilities. Quantitative data were collected using structured questionnaires and analysed with descriptive statistics, Pearson chi-square tests, and multivariable binary logistic regression. The modelled outcome was optimal adherence, operationally defined in this study as taking at least 95% of prescribed doses without an interruption exceeding 48 consecutive hours. Qualitative data were obtained from eight key-informant interviews with healthcare providers and four focus-group discussions involving 28 women and were analysed thematically. Results: Optimal adherence was observed in 146 participants (48.7%), whereas 154 (51.3%) were classified as sub-optimally adherent. In the adjusted model, women aged 25-34 years had higher odds of optimal adherence than those aged 15-24 years (aOR = 2.45, 95% CI 1.38-4.36; p = .002). Higher odds of optimal adherence were also observed among married women (aOR = 1.92, 95% CI 1.09-3.38), women with secondary or tertiary education (aOR = 1.88, 95% CI 1.06-3.34), those with monthly income >=1000 ZMW (aOR = 1.79, 95% CI 1.03-3.11), urban residents (aOR = 2.23, 95% CI 1.24-4.01), and women living <=5 km from a health facility (aOR = 2.14, 95% CI 1.22-3.75). Participant-reported ART availability, satisfaction with counselling, and receipt of follow-up support were significantly associated with adherence in bivariate analyses. Qualitative findings described interacting barriers related to poverty and distance, social relationships and disclosure, health-service experiences, and the tension between treatment knowledge and day-to-day constraints. Conclusion: Sub-optimal ART adherence was common in this facility-based sample. The findings support locally adapted strategies that reduce access barriers, strengthen patient-centred counselling and follow-up, and account for social and economic vulnerability, while recognising that the cross-sectional design does not establish causality.