Determinants of option B+ HIV treatment adherence among HIV-positive breastfeeding women in Zimbabwe.

Zimbabwe is one of the countries in sub-Saharan Africa with the highest prevalence of HIV. Despite the launch of the Option B+ treatment approach in 2013 to eliminate mother-to-child transmission, the number of pregnant women and children living with HIV is still high due to non-adherence. This prompted this study with the aim to explore the determinants of adherence to Option B+ HIV treatment among HIV-positive breastfeeding women. This descriptive phenomenological study explored the lived experiences of 12 purposively recruited HIV-positive breastfeeding women in 2020 through in-depth interviews. The collected data were analysed using Colaizzi's phenomenological data analysis framework. The study findings revealed that client-related factors such as food insecurity, travel, early infant diagnosis, and treatment-related factors such as the unavailability of drugs, the side effects of medications, and health institution-related factors are barriers to adherence among HIV-positive breastfeeding women. The findings also indicated that support from the family, health care workers, awareness of the benefits of the treatment plan, and positive role models are promoters of adherence. To improve breastfeeding women's adherence to Option B+ HIV treatment, the identified barriers to adherence should be addressed while optimising the motivators of adherence.

Le Zimbabwe est l'un des pays d'Afrique subsaharienne où la prévalence du VIH est la plus élevée. Malgré le lancement de l'approche thérapeutique Option B+ en 2013 pour éliminer la transmission mère-enfant, le nombre de femmes enceintes et d'enfants vivant avec le VIH reste élevé en raison de la non-observance. Cela a incité cette étude dans le but d'explorer les déterminants de l'observance du traitement anti-VIH Option B+ chez les femmes séropositives qui allaitent. Cette étude phénoménologique descriptive a exploré les expériences vécues de 12 femmes allaitantes séropositives recrutées à dessein en 2020 au moyen d'entretiens approfondis. Les données collectées ont été analysées à l'aide du cadre d'analyse de données phénoménologiques de Colaizzi. Les résultats de l'étude ont révélé que des facteurs liés aux clients, tels que l'insécurité alimentaire, les voyages, le diagnostic précoce du nourrisson et des facteurs liés au traitement, tels que l'indisponibilité des médicaments, les effets secondaires des médicaments et les facteurs liés aux établissements de santé, constituent des obstacles à l'observance chez les personnes infectées par le VIH. -les femmes qui allaitent positivement. Les résultats ont également indiqué que le soutien de la famille, des agents de santé, la conscience des avantages du plan de traitement et des modèles positifs sont des facteurs favorisant l'observance. Pour améliorer l'observance des femmes qui allaitent au traitement du VIH Option B+, les obstacles identifiés à l'observance doivent être surmontés tout en optimisant les facteurs de motivation de l'observance.

The Psychosocial Profile of Women Who Defaulted Option B+ HIV Treatment: An Interpretive Phenomenological Analysis Study.

Purpose: The study explored the psychosocial profile of women who defaulted Option B+ HIV treatment at Chitungwiza Municipality clinics in Zimbabwe. Option B+ is a strategy to prevent mother-to-child transmission (PMTCT) of HIV to reduce MTCT rate to less than or equal to 5%. Methods: An interpretive phenomenological analysis (IPA) design was used. Data were collected from 04 September to 12 October 2020 on twelve purposively selected HIV-positive breastfeeding women aged 18 to 40 years, who defaulted Option B+ HIV treatment. Unstructured individual face-to-face interviews were utilised. Data were analysed thematically using the interpretive phenomenological analysis framework for data analysis. Results: The study findings revealed that participants experienced the following: psychosocial and emotional challenges due to HIV positive results, shown emotional distress and suicidal tendencies which affected their mental health. Their relationship was derailed due to abuse, infidelity, partner's high-risk behaviour and to lack of support stemming from their partners and family members. Conclusion: Strengthening adherence support interventions and effective counselling on HIV-positive status disclosure and male partner involvement is important for retaining women in care and for improving their quality of life. Comprehensive, integrated, and tailor-made interventions should be adopted. Couple HIV counselling and testing should be encouraged. Psychosocial and mental health should be encouraged. Furthermore, community sensitization, risk reduction behaviour, education on purpose and side effects of ART as well as the benefits of Option B+ to new enrolments should be intensified and strengthened to minimize defaulting of treatment and LTFUP. Vigorous patient tracing and visit reminders help retain women in care.

A randomized controlled safety trial of the diaphragm and cellulose sulfate microbicide gel in sexually active women in Zimbabwe.

BACKGROUND: Cellulose sulfate (CS) is an antimicrobial and contraceptive agent. We assessed its safety when used alone or with the diaphragm in Harare, Zimbabwe. STUDY DESIGN: This was a randomized controlled safety trial with three arms: diaphragm with 6% CS gel vs. diaphragm with KY gel vs. CS gel alone. Participants were instructed to use their study products before every sex act for a period of 6 months. Safety end points were assessed monthly by questionnaires and urinanalysis and bimonthly by clinical examinations, colposcopy, wet mounts and gram stains. RESULTS: One hundred nineteen monogamous women were enrolled (28% HIV+) and 105 (88%) completed the study. No urinary tract infections were diagnosed during the study; 81.4% women had symptoms and/or signs of genital irritation considered at least possibly related to the gel or device, and 41.5% had changes in vaginal flora. There were no statistically significant differences between treatment groups in safety end points. All six women with deep epithelial disruption were diaphragm users, and all such findings were on the external genitalia. Of those, 4 had herpetic ulcers which were unrelated to products use. CONCLUSIONS: Cellulose sulfate appeared safe when used for 6 months alone or with a diaphragm.