Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection
Abstract Background Women who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of “readiness” drives early disengagement from care and undermines prevention of HIV transmi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | AIDS Research and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12981-023-00509-z |
| _version_ | 1797849848489181184 |
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| author | Mwangelwa Mubiana-Mbewe Samuel Bosomprah Rakesh Kumar Saroj Jillian Kadota Aybuke Koyuncu Kusanthan Thankian Michael J. Vinikoor |
| author_facet | Mwangelwa Mubiana-Mbewe Samuel Bosomprah Rakesh Kumar Saroj Jillian Kadota Aybuke Koyuncu Kusanthan Thankian Michael J. Vinikoor |
| author_sort | Mwangelwa Mubiana-Mbewe |
| collection | DOAJ |
| description | Abstract Background Women who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of “readiness” drives early disengagement from care and undermines prevention of HIV transmission to infants. Several studies have shown high early attrition of women initiating ART in pregnancy. Although poor ART uptake and adherence have been attributed to various factors including stigma, disclosure issues and structural issues, there is no standard way of determining which pregnant woman will face challenges and therefore need additional support. We developed and validated a novel ART readiness tool in Lusaka, Zambia. Methods The aim of this study was to develop and validate a tool that could be used to assess how ready a newly diagnosed pregnant woman living with HIV would be to initiate ART on the day of diagnosis. Using a mixed method design, we conducted this study in three public-setting health facilities in Lusaka, Zambia. Informed by qualitative research and literature review, we identified 27 candidate items. We assessed content validity using expert and target population judgment approaches. We administered the 27-item questionnaire to 454 newly diagnosed pregnant women living with HIV, who were enrolled into a randomized trial (trials number NCT02459678). We performed item reduction analysis and used Cronbach’s alpha coefficient of 0.70 as threshold for reliability. Results A total of 454 pregnant women living with HIV enrolled in the study between March 2017 and December 2017; 452 had complete data for analysis. The correlation coefficient between the 27 items on the completed ART readiness scale ranged from 0.31 to 0.70 while item discrimination index ranged from -0.01 to 2.38. Sixteen items were selected for the final scale, representing three domains, which we classified as “internalized and anticipated HIV stigma”, “partner support” and “anticipated structural barriers”. Conclusion We developed and validated a tool that could be used to assess readiness of newly diagnosed women living with HIV to initiate ART. This ART readiness tool could allow clinics to tailor limited resources to pregnant women living with HIV needing additional support to initiate and remain on ART. |
| first_indexed | 2024-04-09T18:51:51Z |
| format | Article |
| id | doaj.art-952bfb6b06324699b352aa778f0060a6 |
| institution | Directory Open Access Journal |
| issn | 1742-6405 |
| language | English |
| last_indexed | 2024-04-09T18:51:51Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | AIDS Research and Therapy |
| spelling | doaj.art-952bfb6b06324699b352aa778f0060a62023-04-09T11:27:24ZengBMCAIDS Research and Therapy1742-64052023-04-012011910.1186/s12981-023-00509-zDevelopment and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infectionMwangelwa Mubiana-Mbewe0Samuel Bosomprah1Rakesh Kumar Saroj2Jillian Kadota3Aybuke Koyuncu4Kusanthan Thankian5Michael J. Vinikoor6Centre for Infectious Diseases Research in ZambiaCentre for Infectious Diseases Research in ZambiaSchool of Computational and Integrative Sciences, Jawaharlal Nehru UniversityUCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine San Francisco General Hospital, University of CaliforniaDepartment of Epidemiology, Johns Hopkins UniversityDepartment of Gender Studies, University of ZambiaCentre for Infectious Diseases Research in ZambiaAbstract Background Women who are newly diagnosed with HIV infection during pregnancy may not be ready to immediately initiate lifelong antiretroviral therapy (ART; called Option B +) as is recommended. Lack of “readiness” drives early disengagement from care and undermines prevention of HIV transmission to infants. Several studies have shown high early attrition of women initiating ART in pregnancy. Although poor ART uptake and adherence have been attributed to various factors including stigma, disclosure issues and structural issues, there is no standard way of determining which pregnant woman will face challenges and therefore need additional support. We developed and validated a novel ART readiness tool in Lusaka, Zambia. Methods The aim of this study was to develop and validate a tool that could be used to assess how ready a newly diagnosed pregnant woman living with HIV would be to initiate ART on the day of diagnosis. Using a mixed method design, we conducted this study in three public-setting health facilities in Lusaka, Zambia. Informed by qualitative research and literature review, we identified 27 candidate items. We assessed content validity using expert and target population judgment approaches. We administered the 27-item questionnaire to 454 newly diagnosed pregnant women living with HIV, who were enrolled into a randomized trial (trials number NCT02459678). We performed item reduction analysis and used Cronbach’s alpha coefficient of 0.70 as threshold for reliability. Results A total of 454 pregnant women living with HIV enrolled in the study between March 2017 and December 2017; 452 had complete data for analysis. The correlation coefficient between the 27 items on the completed ART readiness scale ranged from 0.31 to 0.70 while item discrimination index ranged from -0.01 to 2.38. Sixteen items were selected for the final scale, representing three domains, which we classified as “internalized and anticipated HIV stigma”, “partner support” and “anticipated structural barriers”. Conclusion We developed and validated a tool that could be used to assess readiness of newly diagnosed women living with HIV to initiate ART. This ART readiness tool could allow clinics to tailor limited resources to pregnant women living with HIV needing additional support to initiate and remain on ART.https://doi.org/10.1186/s12981-023-00509-zHIVPregnant womenART readinessOption B + ART initiation |
| spellingShingle | Mwangelwa Mubiana-Mbewe Samuel Bosomprah Rakesh Kumar Saroj Jillian Kadota Aybuke Koyuncu Kusanthan Thankian Michael J. Vinikoor Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection AIDS Research and Therapy HIV Pregnant women ART readiness Option B + ART initiation |
| title | Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection |
| title_full | Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection |
| title_fullStr | Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection |
| title_full_unstemmed | Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection |
| title_short | Development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban Zambia with newly diagnosed HIV infection |
| title_sort | development and validation of a novel scale for antiretroviral therapy readiness among pregnant women in urban zambia with newly diagnosed hiv infection |
| topic | HIV Pregnant women ART readiness Option B + ART initiation |
| url | https://doi.org/10.1186/s12981-023-00509-z |
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