Female adherence self-efficacy before and after couple HIV testing and counseling within Malawi’s Option B+ program

ABSTRACT

Adherence self-efficacy, belief in one’s ability to adhere to daily medication, is strongly associated with antiretroviral therapy (ART) adherence and preventing mother-to-child HIV transmission. Couple-based interventions could enhance self-efficacy and adherence. We assessed the relationship between couple HIV testing and counseling (cHTC) and adherence self-efficacy using a 100-point culturally-adapted adherence self-efficacy scale (ASES). Secondarily, we explored the relationship between ASES and ART adherence. Ninety HIV-positive pregnant women at an antenatal clinic in Lilongwe, Malawi were enrolled in an observational cohort study. They were assessed with ASES immediately before and one month after receiving cHTC. Median ASES scores were 100 (IQR 95, 100) before and 100 (IQR 99, 100) after cHTC; there was a significant median difference (p = 0.02) for participants before and after cHTC. This change in ASES scores was associated with the odds of self-reported ART adherence in the full population (OR 1.1, p = 0.01), and there was a trend in the same direction for participants with imperfect baseline ASES scores (OR 1.1, p = 0.2). In our population, adherence self-efficacy and ART adherence were both quite high, and those who had room to improve in self-efficacy may have benefited from cHTC, which in turn could impact ART adherence and ultimately mother-to-child transmission.

KEYWORDS:

• Adherence
• self-efficacy
• HIV
• couples
• Malawi

Acknowledgements

We would like to acknowledge the contributions of all the participants who shared their opinions. We also would like to thank the Lilongwe District Health Office and the staff of Bwaila Hospital for their support of the study, as well as Lauren Graybill for assisting with data management.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Austin Wesevich http://orcid.org/0000-0001-5202-1231

Nivedita Bhushan http://orcid.org/0000-0002-3417-3263

Additional information

Funding

This work was supported by UNC Hopkins Morehouse Tulane Fogarty Global Health Fellows Program under [grant number R25 TW009340]; National Institute of Mental Health under [grant number R00 MH104154]; the National Institute of Allergy and Infectious Diseases under [grant number P30 AI50410 and R01 AI131060-01]; Eunice Kennedy Shriver National Institute of Child Health and Human Development under [grant number [R01HD080485]; the National Institute for Health Research using Official Development Assistance (ODA) funding (NIHR Global Health Research Professorship, Professor Nuala McGrath, grant number RP-2017-08-ST2-008), and Doris Duke Charitable Foundation International Clinical Research Fellows Program at University of North Carolina at Chapel Hill. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health and Social Care in the UK.