The complexities of maternal non-adherence to antiretroviral therapy and its impact on mother-to-child transmission of HIV: a scoping review

Abstract

Despite the progress made in expanding access to antiretroviral therapy, maternal non-adherence remains a major barrier to eliminating mother-to-child transmission of HIV and safeguarding infants' right to health. This scoping review maps and synthesises existing literature on maternal non-adherence to ART and the perspectives of nursing professionals supporting adherence, who are often underrepresented in research. A total of 34 studies published between 2020 and 2025 were included in the review conducted from January to July 2025 using the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Databases searched included JSTOR, EBSCOhost, ScienceDirect, Wiley Online Library, and Web of Science. Eligible studies comprised qualitative, quantitative, mixed-methods, and systematic reviews on maternal ART non-adherence, MTCT outcomes, and nursing experiences. Data were thematically analysed using Braun and Clarke's framework. Maternal non-adherence was found to be shaped by psychosocial distress, socioeconomic hardship, cultural beliefs, health system constraints, and timing of ART initiation. It heightened mother-to-child transmission risk through viral non-suppression, postpartum default, and programmatic gaps. Strengthening adherence requires effective communication, supportive care, patient-centred counselling, service integration, and systematic monitoring. Addressing mothers' lived realities while empowering nurses to deliver empathetic, context-specific care is key to improving adherence and reducing mother-to-child transmission of HIV in resource-limited settings.