Tenofovir Adherence in the Prevention of Mother-to-Child Transmission of Hepatitis B in the Democratic Republic of the Congo: A Qualitative Study Applying the Information-Motivation-Behavioral Skills Model

Abstract Background: Hepatitis B virus (HBV) remains a leading infectious cause of death worldwide, and is highly prevalent in Sub-Saharan Africa (SSA). The prevention of mother-to-child transmission (PMTCT) programs for HBV are critical to reaching elimination targets and utilizing existing HIV testing and treatment infrastructure. Building on a feasibility study to introduce tenofovir disoproxil fumarate antiviral therapy to pregnant women with high-risk HBV in the Democratic Republic of the Congo (DRC), we examine the social and psychological facilitators of medication adherence of women who participated in this HBV PMTCT program.Methods: This study utilizes a qualitative exploratory approach involving women in Kinshasa, DRC who were identified as high-risk HBV during pregnancy and completed the pilot tenofovir antiviral program. Six participants were identified and completed in-depth, open-ended phone interviews. This study adopts a modified Information-Motivation-Behavioral Skills model (IMB+) to identify emerging themes related to tenofovir adherence.Results: A strong trust in healthcare workers, family support, and improved awareness of the disease and treatment options through enrollment in the PMTCT program facilitated tenofovir adherence. Barriers to medication adherence included social stigma and low healthcare literacy specific to HBV.Conclusions: Our study highlights the feasibility of medication adherence in HBV PMTCT programs in a low-resource setting and the importance of incorporating initiatives that address hepatitis B stigma and other social barriers. These findings are relevant to future HBV PMTCT scale-up, which is needed in the DRC and in similar African contexts with high HBV prevalence. Trial registration: The parent study was registered with clinicaltrials.gov under identifier NCT03567382. Date of registration: 25/06/2018