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

Abstract

Among women with HIV infection, pregnancy is a time when maintenance of maternal health and reduction of vertical HIV transmission are primary concerns. Few studies have examined adherence to Antiretroviral Treatment (ART) during pregnancy and in the postpartum period when the demands of childcare may significantly interfere with women's self-care behaviors. This study examined ART use and adherence in HIV-infected pregnant and postpartum women participating in the Women and Infants Transmission Study (WITS-IV) in the US. Adherence was assessed through a self-report interview during the third trimester of pregnancy and six-month postpartum. Data were also collected on demographics, biomedical markers and health related symptoms. During the third trimester visit, 77% (309/399) of women completed the self-report adherence measure; 61% (188/309) reported complete adherence. Factors associated with non-adherence included advanced HIV disease status, higher HIV-RNA viral load, more health-related symptoms and alcohol and tobacco use. At six-month postpartum, 55% (220/399) completed the measure; 44% (97/220) of these women reported complete adherence. Factors associated with non-adherence during the postpartum period were ethnicity, more health-related symptoms and WITS clinical site. Results of multivariate analyses using Generalized Estimated Equation analyses across the two visits revealed that more health-related symptoms, higher HIV-RNA viral load, increased alcohol use and clinical site were independently associated with ART non-adherence. These analyses indicate that medication adherence is more likely during pregnancy than postpartum in HIV-infected women, perhaps provoked by motivation to reduce vertical transmission and/or intensive antepartum surveillance. Further investigation is warranted to clarify factors implicated in women's decision-making process regarding ART medication adherence.

Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program

“…Translation of behavioral interventions for people living with HIV/AIDS (PLWHAs) that addresses multiple risk behaviors is especially appropriate, as PLWHAs have been identified as being at increased risk of comorbid health conditions, such as cardiovascular and pulmonary diseases, depression, diabetes, and addiction [3,4]. In addition, psychiatric disorders have also been associated with decrements in essential health behaviors for PLWHAs (e.g., antiretroviral medication adherence [5][6][7][8][9] and medical appointment attendance [10,11]) and with poorer overall mental health and quality of life [12,13].…”

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

“…Findings from these studies suggest that the developing emotional relationship between the pregnant woman and her fetus, called maternal-fetal attachment (MFA) in the present study, may motivate women to practice optimal maternal health behaviors (D'Auria et al, 2006;Mellins et al, 2008). This suggestion, however, has not been empirically tested, and the present study does so.…”

“…Mellins et al (2008) and Bardeguez et al (2008) found that advanced HIV status, higher viral load, more overall health-related symptoms, and alcohol, tobacco or marijuana use were positively associated with medication nonadherence; or negatively associated with "perfect adherence." Bardeguez et al observed that "never missing prenatal vitamins" was the only factor significantly associated with perfect adherence to ART in pregnancy.…”

“…None of these national and international surveys of pregnant women with HIV/AIDS measured the relationship between maternalfetal attachment and ART adherence. Nonetheless, they reported that the health of the fetus, the desire to protect the fetus from their own infection, and the motivation to prevent mother-to-child transmission were the primary reasons women offered to account for their better adherence during pregnancy, compared to the period after childbirth (Ekama et al, 2012;Mellins et al, 2008;Michel et al, 2012;Nachega et al). Similar themes, such as getting tested and adhering to ART medication early in pregnancy to protect the health of the fetus and/or proactively guard the women's own health, clearly emerge among the findings of two, one national another international, qualitative studies (Kelly et al, 2012;Njie-Carr et al, 2012).…”

“…Additional contextual psychosocial risk factors and macro-structural forces contributing to problematic ART adherence among women living with HIV/AIDS include: advanced HIV disease, use/history of illegal drugs, homelessness, decreased number of prenatal visits, mental health problems, avoidant coping, intimate partner violence, less disclosure of maternal HIV status to children, increased parenting stress, and single parenthood (Kates et al, 2013;Mellins 2008;Sandelowski 2009;WatkinsHayes et al, 2012). For example, the language, educational, and economic difficulties of the foreign-born HIV-infected women of Rhode Island compromise their ability to adhere with prescribed medication regimens and prenatal or postnatal follow up visits (Firth et al 2012).…”