Abstract:
Introduction: Delayed initiation of antiretroviral therapy during pregnancy results in failure to achieve viral suppression before delivery which in turn increases mother-to-child transmission of HIV. Previous studies examined delayed ART initiation among adult HIV-positive patients and there is limited data regarding this issue among HIV-positive pregnant women in Ethiopia. Objective: This study was aimed to assess magnitude of delayed antiretroviral therapy initiation and associated factors among HIV positive pregnant women in metropolitan cities of Amhara national regional state, Northern Ethiopia, 2023. Methods: A multicenter facility-based cross-sectional study was conducted in randomly selected public health institutions of Bahirdar, Gondar, and Dessie cities. A simple random sampling technique was used to select a total of 389 study participants. The collected data was exported from Kobo toolbox data collection software to SPSS version 27 for analysis. Both descriptive and logistic regression analysis was done. Variables with P- the value <0.2 from bivariable analysis were interred to multivariable analysis. Finally, a p-value of <0.05 and adjusted odds ratio with 95% CI was used to declare the statistical significance. Results: Totally 389 study participants were recruited in the study with response rate of 96.2%. The mean age of respondents was 28.32(SD+5.718). In this study 23.4% (95% CI [19.3-27.8]) of study participant‟s initiate ART delayed. Divorced marital status [AOR=3.51,95% CI(1.61,9.58)], did not get post-test counseling [AOR=2.33,95% CI(1.99,5.73)],did not disclose HIV status [AOR=2.55,95% CI(1.33,4.89)], not know other ART users [AOR=2.74,95% CI(1.42,5.28)],being diagnosed for HIV at the first and second trimesters of pregnancy[AOR=3.61,95%CI(1.84,9.56)]and[AOR=2.62,95%CI(1.23,5.56)respectively,residing out of the catchment area [AOR=2.36,95%CI(1.21,4.61)], not get home-based care [AOR=2.77,95% CI(1.49,5.12) and unplanned pregnancy[AOR=3.35,95%CI(2.98,10.5)]were significantly associated with delay ART initiation. Conclusion and recommendations: Nearly one-fourth of HIV-positive pregnant women had delayed to initiate ART. Intensive post-test counseling, preventing untended pregnancy, creating social linkage, and encouraging further HIV-sero status disclosure need to be strengthened to reinforce early antiretroviral therapy initiation among HIV-positive pregnant women.
