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Table 1 Themes of adherence to medication among HIV positive pregnant women included in qualitative studies (N = 15)

From: Medication adherence in pregnant women with human immunodeficiency virus receiving antiretroviral therapy in sub-Saharan Africa: a systematic review

Domain Themes References (study numbers)
Patient Psychological  
Shock/denial following a positive HIV result [1, 6, 9, 14]
Motivation to protect infant/self/family [6, 9, 10]
Patient knowledge on ART/PMTCT  
Poor knowledge of ART, MTCT [4]
Good knowledge of ART [3]
Self-reported ability to adhere to ART [6, 8]
Patient attitude and personal management  
Late ANC attendance an obstacle to early AZT prophylaxis and initiation on HAART [2]
Missing clinical appointments [1]
Interrupted personal routine [4]
Patient belief system  
Religious belief [13]
Use of traditional medicines [5]
Patient condition Disease progression [13]
Obstetric/ pregnancy  
Uncertainty about onset of labour in order to swallow NVP [1]
Previous experience with PMTCT [9]
Therapy Side effects of ART [6, 13]
Perceived effectiveness of therapy [6, 9]
Social and economic factors Financial difficulty  
Lack of transport fee to go to health facility for pick-up of ARVs [1, 2, 3, 13]
Lack of money to buy food to eat [3, 4, 13]
Women empowerment  
Economically dependent on husbands [3]
Domestic violence either actual or threatened [4]
Lack of male involvement [2]
Cultural conditions and beliefs  
Traditional medicines/healers [4, 5]
Religious beliefs [13]
Partner and community – the challenges of disclosure and non-disclosure  
Fear of disclosure to partner/family members [3, 4, 5, 8, 9, 10, 13, 14]
Disclosure to partner/family(facilitating) [8, 13]
HIV infected relatives stealing tablets [4]
Hiding ARVS within the house/taking ARVs in hiding in the house [4, 5]
Pattern of misinformation on ART in the community [14]
HIV related stigma [2, 5, 9, 10, 13, 15]
Community view of HIV- infected persons had no bearing on their decision to begin or continue ART [3]
Sharing medication with others  
Sharing ARVs with partner/friend [1, 4]
Positive outlook of known patients living with HIV in the community  
Seeing positive results in the community of women taking ART and looking healthy [9, 10, 12]
Health care team/health system Staff related  
Fear of mistreatment by HCWs [1, 3, 7, 10]
HCWs providing good counselling on ART [6, 7, 8]
Supply chain management system  
Delayed supply of ARVs [2, 6, 7]
Resource/Infrastructure and service related  
Prolonged counselling to initiate prophylaxis or ART [2, 3]
Lack of privacy and confidentiality [2, 7]
Inadequate counselling and short contact time with patient [2]
Long waiting time in the health facilities [3, 11]
  1. ANC Antenatal clinic, HCWs Health care workers, ARV Antiretroviral, ART Antiretroviral therapy, MTCT Mother to child transmission of HIV, NVP Nevirapine, AZT Zidovudine. Study numbers = the order in which the references appear on Table 4