Effectiveness of Nurse-Led Health Education Intervention on Adherence to Prevention of Mother to Child Transmission Services among HIV-Positive Women of Reproductive Age in Mombasa County

Abstract

Over 90% of the 180,000 new pediatric HIV infections worldwide in 2017 were due to mother-to-child transmission (MTCT). PMTCT program options, including A, B, and B+, have been designed to prevent this transmission. In option B+, all pregnant and nursing women receive lifetime antiretroviral medication. Increasing uptake and retention of HIV-positive mothers in PMTCT services remains crucial in low- and middle-income countries (LMICs). This study evaluated the effectiveness of a nurse-led health education intervention in improving PMTCT adherence among HIV-positive women in Mombasa County, Kenya. The study, a quasi-experimental design, involved an intervention group (112 women) and a control group (100 women). Data on socio-demographic characteristics, PMTCT adherence, self-stigma, and HIV status disclosure to sexual partners were collected through entry and exit questionnaires. Data were analyzed using SPSS version 26.0, with chi-square used to assess associations and the difference-in-difference (DiD) approach to evaluate the intervention's effectiveness. At baseline, no significant differences in demographics between the groups were observed. The multivariate analysis showed that women with higher education had significantly increased odds of adhering to PMTCT, with secondary education (AOR=1.81, p=0.031), college (AOR=2.01, p=0.022), and university education (AOR=2.24, p=0.050) compared to primary education. Additionally, socioeconomic factors such as income and occupation played a crucial role, as women earning more than 60,000 KSh (AOR=4.23, p<0.001) and those in business or employment had lower adherence odds compared to housewives (AOR=0.22, p=0.004). PMTCT adherence improved significantly in the intervention group (χ2=5.912, p=0.015). At baseline, self-stigma and disclosure rates were similar between the groups. Self-stigma was significantly reduced in the intervention group at the end-line (χ2=151.096, p<0.0001). HIV status disclosure to sexual partners also increased significantly in the intervention group (χ2=47.618, p<0.001). At baseline, no significant difference in PMTCT adherence was observed between the intervention and control groups (p=0.267). After DiD analysis the intervention showed a net impact on PMTCT adherence (36.9%, p<0.0001), self-stigma reduction (35.5%, p<0.0001), and HIV status disclosure (23.1%, p<0.0001). In conclusion, nurse-led health education proved effective in improving PMTCT adherence, reducing self-stigma, and increasing HIV status disclosure. Integrating nurse-led interventions into PMTCT programs is recommended to enhance uptake and reduce mother-to-child transmission in LMICs. These results contribute to the body of knowledge by providing empirical evidence on the benefits of nurse-led interventions in PMTCT services, particularly in LMICs. Additionally, these findings can inform policies aimed at maximizing the role of nurses in providing health education in PMTCT services.