Access to water and toilet facilities as a predictor of adherence to antiretroviral treatment in women living with HIV/AIDS in Zambia: a cross-sectional study

Abstract

Background: Mother-to-child transmission (MTCT) of HIV is a major problem in sub-Saharan Africa despite increasing availability of free antiretroviral treatment (ART). Early diagnosis and continuous engagement in HIV care are essential for the elimination of MTCT and improvement of a mother's quality of life. MTCT risk can be reduced from 45%, with no intervention, to below 5% with the administration of an effective antiretroviral regimen. An important but less explored area is how access to potable water and adequate sanitation influence women's adherence to ART. WHO estimates are that around 319 million people lack access to potable water and 695 million people do not have adequate sanitation in sub-Sharan Africa. The aim of this study was to investigate how access to water, sanitation, and hygiene (WASH) influence ART adherence in women living with HIV/AIDS in Zambia. Methods: A cross-sectional study was conducted in women living with HIV/AIDS attending prenatal and postnatal clinics in Lusaka and Sinazongwe Districts, Zambia. We used a questionnaire to collect information on sociodemographic characteristics, WASH, quality of health care, disclosure and support, and other factors. Associations between categorical and continuous variables were assessed with Pearson's χ2 and correlation, respectively. Factors influencing ART adherence were determined using logistic regression models. Findings: We included data from 150 women in analysis; mean age was 29 years (SD 6). In all, 64% of respondents reported that they lacked access to potable water and 70% reported having inadequate toilet facilities. There were significant associations between ART adherence and access to toilet facilities (p=0·01) and women's perception about access to water and importance of clean water (p=0·01). There was a significant association between ART adherence and belief about effectiveness of the antiretroviral drugs (p=0·01). Participants who were worried about their access to water were less likely to adhere to ART (adjusted OR=0·36 [95% CI 0·13–0·98]; p=0·046) and women who were worried about lack of a toilet facility in their house were less likely to adhere to ART (0·11 [0·03–0·39]; p=0·001). Interpretation: Access to water and toilet facilities influence ART adherence in women living with HIV or AIDS. Interventions aimed at improving ART adherence should include access to WASH facilities. Funding: None.