Using a composite adherence tool to assess ART response and risk factors of poor adherence in pregnant and breastfeeding HIV-positive Cameroonian women at 6 and 12 months after initiating option B+

Abstract

BackgroundAntiretroviral therapy (ART) adherence in preventing HIV mother-to-child transmission in association with virological suppression and risk factors of low adherence in the Cameroon’s Option B+ programme are poorly understood. We used a composite adherence score (CAS) to determine adherence and risk factors of poor adherence in association with virological treatment response in HIV-positive pregnant and breastfeeding women who remained in care at 6 and 12 months after initiating ART.MethodsWe prospectively enrolled 268 women after ART initiation between October 2013 and December 2015 from five facilities within the Kumba health district. Adherence at 6 and 12 months were measured using a CAS comprising of a 6-month medication refill record review, a four-item self-reported questionnaires and a 30-day visual analogue scale. Adherence was defined as the sum scores of the three measures and classified as high, moderate and low. Measured adherence levels were compared to virological suppression rates at month 12 and risk factors of poor adherence were determined.ResultsAt 6 and 12 months, 217 (81.0%) and 185 (69.0%) women were available for adherence evaluation. Respectively. Of those, 128 (59.0%) and 68 (31.4%) had high or moderate adherence as per the CAS tool at month 6, and 116 (62.7%) and 48 (24.9%) at month 12, respectively. Viral loads were assessed in 165 women at months 12, and 92.7% had viral suppression (< 1000 copies/mL). Viral suppression was seen in 100% of women with high, 89.5% with moderate, and 52.9% with low adherence using the CAS tool. Virological treatment failure was significantly associated with low adherence [OR 7.6, (95%CI, 1.8–30.8)]. Risk factors for low adherence were younger age [aOR 3.8, (95%CI, 1.4–10.6)], primary as compared to higher levels of education [aOR 2.7, (95%CI, 1.4–5.2)] and employment in the informal sector compared to unemployment [aOR 1.9, (95%CI,1.0–3.6)].ConclusionsDuring the first year of Option B+ implementation in Cameroon our novel CAS adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression. Younger age, less educated and informal sector employed women may need more attention for optimal adherence to reduce the risk of virological failure.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2058-9) contains supplementary material, which is available to authorized users.

The syndemic effects of mental ill health, household hunger, and intimate partner violence on adherence to antiretroviral therapy among pregnant women living with HIV in Yaoundé, Cameroon

“…Previous estimates of suboptimal ART adherence among pregnant WLWH in Cameroon were lower than reported in this study. A study of pregnant or breastfeeding WLWH in Cameroon found that 20% of study participants reported moderate ART adherence and 7% reported low ART adherence (measured using a four-item self-report questionnaire) six months after initiating Option B+ [ 42 ]. A study of PLWH (men and women) in Cameroon found that between 23% and 35% of participants reported recent non-adherence to ART regimens [ 8 ].…”

Comparing self-reported medication adherence measures with hair antiretroviral concentration among people living with HIV in Guangxi, China

“…While these studies provide important information regarding the validity of self-reported measures, data are limited in Chinese PLHIV and comparison of those self-reported measures with long-term biological measures of adherence. In addition, some studies used a composite adherence score (CAS) from several self-reported measures with the hope to offset or reduce potential biases in self-reporting [27][28][29]. Several studies employed CAS measures to predict objective measures of adherence (e.g., device-based measures and viral load) [17,18,26], and did not find advantages over the individual self-reported measures.…”

Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review

“…Studies that did not measure adherence as an outcome were excluded from the systematic review. Thirty-one journal articles met the inclusion criteria [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] and were included in the systematic review. Figure 1 shows the flowchart of the systematic review process.…”

“…The study designs consisted of ten cohort studies [ 24 , 25 , 29 , 33 , 34 , 37 , 38 , 47 , 52 , 53 ], four pre-post studies [ 26 , 28 , 35 , 36 ], sixteen randomized controlled trials [ 27 , 31 , 32 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 54 ], and only one cross-sectional study [ 30 ].…”

“…The intervention categories as described on Table 2 comprised of structural intervention [ 24 , 26 , 29 , 32 , 33 , 34 , 35 , 51 ], which involved intervention types such as community health worker’s home visits [ 24 ], community-based support (CBAS) groups [ 24 , 33 ], option B+ [ 25 ], mobile pharmacy [ 34 ], semi-mobile clinics [ 35 ], micro clinics, and community-based care by personal digital assistant [ 51 ]. Interventions that were within the affective category [ 24 , 25 , 26 , 27 , 28 , 30 , 31 , 41 , 42 , 43 , 44 , 50 , 54 ] included counseling [ 27 , 28 , 38 , 43 ], peer support groups [ 30 ], adherence treatment supporter [ 37 , 42 ], and psychotherapy [ 46 ]. Interventions in the cognitive category [ 39 , 40 , 49 , 50 ] involved patient education [ 39 ] and active visualization [ 40 ].…”