Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu

doi:10.1371/journal.pone.0229592

Cited by 12 publications

(14 citation statements)

References 24 publications

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“… 73 Independent of breastfeeding, alcohol use post-delivery may exacerbate other postpartum stressors and negatively impact ART adherence and retention in HIV care. 74 There is also a strong association between alcohol use postpartum and maternal depression. 75 – 77 As another limitation, the parent study did not use the full version of the modified Brief COPE scale, which precluded analysis that might have revealed important relationships between coping styles assessed by specific subscales (eg, avoidance, alcohol use to cope) and the 4 alcohol use groups.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda

Stanton

Hornstein

Musinguzi

et al. 2023

J Int Assoc Provid AIDS Care

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Identifying factors associated with alcohol use changes during pregnancy is important for developing interventions for people with HIV (PWH). Pregnant PWH (n = 202) initiating antiretroviral therapy in Uganda and South Africa completed two assessments, 6 months apart (T1, T2). Categories were derived based on AUDIT-C scores: “no use” (AUDIT-C = 0 at T1 and T2), “new use” (AUDIT-C = 0 at T1, >0 at T2), “quit” (AUDIT-C > 0 at T1, =0 at T2), and “continued use” (AUDIT-C > 0, T1 and T2). Factors associated with these categories were assessed. Most participants had “no use” (68%), followed by “continued use” (12%), “quit” (11%), and “new use” (9%). Cohabitating with a partner was associated with lower relative risk of “continued use.” Borderline significant associations between food insecurity and higher risk of “new use” and between stigma and reduced likelihood of “quitting” also emerged. Alcohol use interventions that address partnership, food security, and stigma could benefit pregnant and postpartum PWH.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda

Stanton

Hornstein

Musinguzi

et al. 2023

J Int Assoc Provid AIDS Care

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“…Responses from 319 parturient women, who confirmed that they had initiated complementary feeding before six months to their infants, were analysed thematically in this sub-study. All mothers were on antiretroviral therapy, however, close to one in three women reported adherence challenges [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study

2020

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Exclusive breastfeeding has many health benefits for the baby and the mother. This study explored the reasons for the early introduction of supplementary feeding before six months, and the issues faced by parturient women in practicing exclusive breast feeding (EBF) for their HIV-exposed infants in the Eastern Cape, South Africa. Narratives from 319 parturient women with HIV (aged 18 years and above) were collected at three hospitals in the Eastern Cape through semi-structured interviews over a period of five months. Qualitative data were analysed using thematic content analysis. The maternal perception of HIV transmission from breast milk influenced the decision for the immediate introduction of formula feeding. Breast sores, lumps, surgery and perceived insufficiency of milk influenced the decision of mothers to initiate formula feeding within the first two months. However, mothers who initiated complementary feeding after two months were driven by factors common among newborns (refusal of breast milk, baby crying inconsolably and fear of losing weight) and social factors (economic or financial hardships and work-related challenges). Additionally, advice from family members weighed heavily in the decision to switch to complementary feeding, contrary to the healthcare providers’ recommendations. Early complementary feeding for HIV-exposed infants is influenced by maternal perceptions of breast milk transmission, breast and infant factors and socio-economic and cultural practices in the region. Thus, behavioural interventions tailored towards promoting exclusive breastfeeding practices in this population, starting from the pre-natal and continuing during the post-partum period, should also target the immediate family members. National policy should focus on creating an EBF-friendly environment at the workplace for women.

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“…Disengagement from care among postpartum WRLHIV is common in SA and other high HIV burden countries and may lead to women becoming viraemic as a result of non-adherence to ART. [31][32][33] In SA, this has important programmatic implications given the extended breastfeeding period of up to 24 months among WRLHIV on ART. [34] In order to achieve eMTCT, the programme requires better systems for tracking WRLHIV throughout pregnancy and the postpartum period to enable retention in care and efficient VL monitoring to guide clinical management in this population.…”

Section: Researchmentioning

confidence: 99%

Population-level risk factors for vertical transmission of HIV in the national prevention of mother-to-child transmission programme in South Africa: An ecological analysis

Moyo

Mazanderani

Sherman

et al. 2022

SAMJ

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Background. Although South Africa has an overall mother-to-child transmission (MTCT) of HIV rate <5%, case rates remain high. Objectives. To identify population-level predictors of MTCT to inform targeted interventions to further reduce paediatric HIV incidence. Methods. The study was an ecological analysis of routine laboratory HIV-related test data from a synthetic cohort of women of reproductive age living with HIV (WRLHIV), identified from the National Health Laboratory Service’s Corporate Data Warehouse between 2016 and 2017. Criteria based on syphilis screening and timing of HIV-related tests were used to identify pregnant and non-pregnant WRLHIV. Pregnant WRLHIV were followed from cohort entry at the first antenatal care (fANC) visit, through delivery to exit at the latest viral load (VL) or 15 months post delivery. Follow-up for non-pregnant WRLHIV started at cohort entry on 1 January 2016 to exit at the latest VL or 31 December 2018. HIV VL tests performed at cohort entry, delivery and cohort exit described viraemia (VL ≥50 copies/mL) at subdistrict level. A negative binomial regression model determined the association between MTCT cases and the number of viraemic WRLHIV at different time points, controlling for number of WRLHIV aged <25 years at cohort entry and other routine HIV-related indicators at subdistrict level. Results. Of 3 386 507 WRLHIV identified, 178 319 (5.3%) met criteria for pregnancy. Median (interquartile range (IQR)) proportions of women with fANC booking <20 weeks’ gestation, maternal HIV seroprevalence during antenatal care (ANC) and antiretroviral therapy (ART) coverage during ANC were 68.2% (62.9 - 72.8), 31.5% (23.4 - 35.7) and 94.8% (89.7 - 97.8), respectively. Viraemia was consistently higher in pregnant v. non-pregnant WRLHIV at median proportions of 42.9% (38.3 - 59.3) v. 35.0% (25.9 - 49.0) at cohort entry (p<0.001) and 36.3% (25.0 - 48.4) v. 29.6% (21.0 - 42.6) at cohort exit (p<0.001). In total, 4 535 children aged <24 months tested HIV polymerase chain reaction-positive, representing a median subdistrict-level case rate of 1 372 (914 - 2 077) per 100 000 live births. Maternal viraemia postpartum, maternal HIV seroprevalence and ART coverage during ANC positively correlated with cases of MTCT, while higher proportions of women with fANC booking <20 weeks’ gestation were associated with a decline in MTCT cases. Conclusions. Findings suggest that maternal viraemia postpartum, geographical areas with a higher burden of maternal HIV, women initiating ART late in pregnancy and/or incident maternal HIV during pregnancy are significant population-level predictors of MTCT in the national prevention of MTCT programme. Scale-up of HIV prevention services is required to lower maternal HIV prevalence, while expanded access to HIV testing will fast-track ART initiation among WRLHIV. Increased VL monitoring is critical to improve VL suppression rates for elimination of MTCT.

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Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

Cited by 12 publications

References 24 publications

Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda

Factors Associated With Changes in Alcohol Use During Pregnancy and the Postpartum Transition Among People With HIV in South Africa and Uganda

Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study

Population-level risk factors for vertical transmission of HIV in the national prevention of mother-to-child transmission programme in South Africa: An ecological analysis

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