Adherence Among Women with HIV Infection in Puerto Rico: The Potential Use of Modified Directly Observed Therapy (MDOT) Among Pregnant and Postpartum Women

Abstract

Women are the fastest growing segment of the adult population acquiring HIV, and most women infected with HIV are in their reproductive years. The success of HAART is highly dependent upon the ability and willingness of the individual to adhere to complex antiretroviral regimens. Improved adherence among HIV-infected pregnant women will delay disease progression in the mother and should also reduce HIV transmission to the baby. Modified directly observed therapy (MDOT), may benefit this population. MDOT has been shown to be an acceptable and feasible intervention among HIV substance users; however, no-one has yet evaluated the use of MDOT in pregnant and postpartum women. Based on semi-structured interviews with 17 Latina women with HIV infection, we explored women's adherence patterns and barriers to adherence and their perceptions of a hypothetical MDOT program. The vast majority of women positively appraised the MDOT program as an effective means to increase and reinforce adherence to demanding drug regimens. Respondents cited the face-to-face contact, the supportive nature of the relationship, and the practical approach of the program as the primary reasons for the effectiveness of MDOT. Results indicate that MDOT could be an acceptable intervention for pregnant and postpartum Latina women to improve adherence to HAART.

Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women

“…Moreover, with the exception of marital status, there were no data on social support, a variable that may be critical to informing interventions for this population. For example, social support and disclosure have been identified in several qualitative studies and one quantitiatve study of HIVpositive pregnant women as important facilitators of adherence (Ciambrone et al, 2006;Wood et al, 2004). Interventions have been developed for other populations of HIV-infected adults that focus on increasing support around adherence through home visits, peer support interventions and couple support AIDS Care 965 interventions (Holstad, DiIorio, & Magowe, 2006;Remien et al, 2007;Williams et al, 2006).…”

“…Interventions have been developed for other populations of HIV-infected adults that focus on increasing support around adherence through home visits, peer support interventions and couple support AIDS Care 965 interventions (Holstad, DiIorio, & Magowe, 2006;Remien et al, 2007;Williams et al, 2006). These strategies may be particularly important to HIVpositive pregnant and postpartum women who are often overwhelmed with caregiving responsibilities and may neglect their own health without support or in the context of non-disclosure of their HIV status to family and friends (Ciambrone et al, 2006).…”

Adherence to Antiretroviral Treatment Decreases During Postpartum Compared to Pregnancy: A Longitudinal Electronic Monitoring Study

“…Conversely, the baby's health was cited as a motivator for adherence. 5 During postpartum, women tend to miss more medical visits, and adherence tends to be lower than during pregnancy. 1,[6][7][8][9][10] Between 10% and 50% of the women stopped their ART after childbirth, part of them on their own without physician's approval.…”

Maternal-Fetal Attachment and Health Behaviors among Women with HIV/AIDS

“…However, the effect sizes observed in the relationships between the maternal-fetal attachment model and these maternal health behaviors ranged, respectively, from medium to medium-large. These findings offer only partial support to the study's hypothesis; however they add emerging credence to similar associations suggested in the qualitative research literature (Ciambrone et al, 2007;D'Auria et al, 2006;Kelly et al, 2012;Njie-Carr et al, 2013). It also suggests potential benefits in attending to the relationship a woman has with her unborn child perhaps as an additional component of her prenatal care to possibly help resolve her struggles with health behaviors.…”

“…The proposed study examines the protective influence maternal-fetal attachment may exert on HIV-, pregnancy-, and infant-related health behaviors among pregnant women living with HIV/AIDS. The desire to protect their fetuses from the threat of transmission might motivate these women to improve ART adherence specifically, and pregnancy-related health behaviors generally (Ciambrone et al, 2007;Mellins et al, 2008).…”