Perceived Barriers to Antepartum HIV Medication Adherence in HIV Infected Pregnant Women

Abstract

Introduction Although rare, perinatal HIV transmission still occurs in the United States and most transmissions are preventable. We aim to identify patient barriers to antiretroviral therapy (ART) adherence during pregnancy and assess patient understanding of perinatal transmission. Methods This cross-sectional survey recruited HIV positive postpartum women at a large safety net hospital in Atlanta, Georgia, between January 2016 and February 2018. Survey questions included demographic characteristics, HIV history, knowledge of perinatal transmission, and ART adherence. Perinatal and HIV outcomes were assessed using chart abstraction. Results Of the 70 HIV infected postpartum women delivered at a large safety net hospital in Atlanta, GA, 45 women were eligible and consented to participate. Participating women were aged 18 to 40 years with an average age of 29 years old, 93% of participants were African-American, and 68% had ≥3 pregnancies. The majority of participants (75%) reported daily ART adherence. “Forgetting” was the most frequent reason for missing pills (57%). Thirteen women had a detectable viral load at the time of delivery and nine of those women had a viral load greater than 1000 copies/mL. Approximately 85% of women who correctly stated ART medications decrease perinatal transmission risk reported daily adherence compared with 50% of women without that knowledge (OR 5.6, 95% CI 1.17, 26.7). Almost half of women (40%) either did not know or believed a vaginal delivery, regardless of viral load, would increase their risk of perinatal transmission. Conclusion Overall, women who were diagnosed with HIV during the current pregnancy, those with planned pregnancies, and those who were on medications prior to pregnancy were more likely to report daily ART adherence. Detectable viral load at delivery is the greatest risk factor for perinatal transmission; therefore strategies to increase ART adherence are needed.

HIV, hepatitis B virus, hepatitis C virus, and syphilis among pregnant women attending antenatal care in Luanda, Angola: Seroprevalence and risk factors

“…Consistent with our results, high HIV prevalence was reported in pregnant women from urbanized areas in the Democratic Republic of the Congo, 20 and Tanzania, 13 but different results were reported in Rwanda, 19 Cameroon, 17 and Ethiopia. 21 In contrast with our results, low HIV prevalence was observed in pregnant women with a high educational level in the USA, 22 and China. 23 The high prevalence of HIV/HBV co-infection observed is not surprising since the HIV/HBV co-infection in sub-Saharan Africa is estimated at 6% to 25%.…”

Association of Literacy-Related Factors to Antiretroviral Therapy Adherence among Sero-Positive Pregnant Women in Murang’a County Referral Hospital, Kenya

“…This therefore means that despite disparities in the level of education there is an association between level of education and ART adherence. These findings confirm that lack of knowledge regarding perinatal transmission is the major hindrance to ART adherence [8]. This knowledge gap can be closed if we continue giving health messages during perinatal visits as was explained by health care workers during the interview.…”

Exploring barriers to antiretroviral therapy adherence among pregnant women: A scoping literature review

“…Three articles revealed that lack of confidence in ART efficacy promoted non adherence to the therapy 23,24,28 . Some women believed that ART was harmful to themselves and their unborn babies 28 and some women discontinued the therapy after experiencing ART adverse effects, leading to doubts in the efficacy of the treatment 23 .…”

“…Three articles revealed that lack of confidence in ART efficacy promoted non adherence to the therapy 23,24,28 . Some women believed that ART was harmful to themselves and their unborn babies 28 and some women discontinued the therapy after experiencing ART adverse effects, leading to doubts in the efficacy of the treatment 23 . In a different study, it was observed that although the women accepted ART, members of the community demonstrated a lack of information about its benefits and consequently discriminated against those who took up the therapy 21 …”