Association between water insecurity and antiretroviral therapy adherence among pregnant and postpartum women in Greater Accra region of Ghana

Bibliographic Data

ID19591642
AuthorsJerry John Nutor (0000-0002-7562-6281, University of California, San Francisco, corresponding author), Jaffer Okiring (0000-0003-3668-8997, Infectious Diseases Research Collaboration), Isaac Yeboah (0000-0001-6795-4405, University of Professional Studies), Rachel Thompson (0000-0001-7233-0242, University of Ghana), Rachel G A Thompson, Pascal Agbadi (0000-0001-5297-2512), Edward Kwabena Ameyaw (0000-0002-6617-237X), Monica Getahun (0000-0002-2116-2637, University of California, San Francisco), Wisdom Agbadi, Thomas J Hoffmann (0000-0003-4129-9478, University of California, San Francisco), Sheri D Weiser (0000-0002-7807-4072, University of California, San Francisco)
EditorsAyse Ercumen (0000-0001-6002-1514)
Year2024
Volume4
Issue1
Pagese0002747
Publication date2024-01-08
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0002747
PMID38190403
OpenAlexW4390660631
LanguageEN
Citations received2
References cited38

Background Adherence to antiretroviral therapy (ART) can substantially reduce morbidity and mortality among women living with HIV (WLWH) and prevent vertical transmission of HIV. However, in sub-Saharan Africa (SSA), more than 50% of new mothers discontinue ART and HIV care after childbirth. The role of water insecurity (WI) in ART adherence is not well-explored. We examined the relationship between WI and ART adherence among pregnant and postpartum WLWH in Greater Accra region of Ghana. Methods Using a cross-sectional survey, we recruited 176 pregnant and postpartum WLWH on ART across 11 health facilities. We examined the association between WI (measured using the Household Water Insecurity Experience Scale, and categorized as moderate and severe WI compard to low WI) and poor ART adherence (defined as scoring a below average observed CASE index score). Bivariate analysis was performed using chi-square test followed by multivariate logistic regression models. We included all variables with p-values less than 0.20 in the multivariate analysis. Results Most (79.5%) of the pregnant and postpartum WLWH enrolled on ART, were urban residents. Over 2/3 were aged 30 years and older. Overall, 33.5% of respondents had poor ART adherence. Proportion of poor ART adherence was 19.4% among those with low WI, 44.4% in those with moderate WI, and 40.0% among those with high WI. Respondents with moderate household water insecurity had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (adjusted Odds ratio (aOR) = 2.76, 95%CI: 1.14–6.66, p = 0.024), even after adjusting for food insecurity. Similarly, respondents with high WI had a greater odds of reporting poor ART adherence, as compared to those with low water insecurity (aOR = 1.49, 95%CI: 0.50–4.48, p = 0.479), even after adjusting for food insecurity. Conclusion Water insecurity is prevalent among pregnant and postpartum WLWH and is a significant risk factor for poor ART adherence. Governments and other stakeholders working in HIV care provision should prioritize water security programming for WLWH along the HIV care continuum

Antiretroviral therapy · Childbirth · Cross-sectional study · Environmental health · Family medicine · Logistic regression · Multivariate analysis · Obstetrics · Odds · Odds ratio · Pregnancy · Viral load · Child Nutrition and Water Access · Demography · Food Security and Health in Diverse Populations · HIV/AIDS Research and Interventions · Medicine · Internal Medicine