Antiretroviral Therapy (ART) Adherence and Prenatal Alcohol Use among Women Who Are Pregnant with HIV in South Africa.

Yukiko Washio,Felicia A Browne,Tracy L Kline,Jacqueline Ndirangu,Wendee M Wechsberg

doi:10.3390/ijerph18147446

Abstract

This brief report emphasizes the need to focus on women with HIV who are pregnant who use alcohol or other drugs. A recently completed implementation science study tested a gender-focused behavioral intervention, the Women’s Health CoOp (WHC), to improve antiretroviral therapy (ART) adherence and reduce alcohol use among women with HIV. The study identified 33 participants who had a positive pregnancy test result at the baseline assessment, of whom five participants remained pregnant during the 6-month duration of the study. Of the 33 pregnant participants at the baseline assessment, 55% reported past-month alcohol use, with 27% reporting a history of physical abuse and 12% reporting a history of sexual abuse. The five women who remained pregnant at 6 months showed improved ART adherence and reduced prenatal alcohol use. The gender-focused WHC intervention shows promise as a cost-effective, sustainable, behavioral intervention to address these intersecting syndemic issues. Future research should focus on identifying the needs of women with HIV who are pregnant who use alcohol or other drugs and developing tailored evidence-based behavioral interventions such as the WHC for preventing FASD in addition to improving ART adherence in this key population of women and reducing the economic burden on society.

Highlights

South Africa has the largest HIV epidemic globally, with 7.1 million people with HIV and over 20% prevalence among the general population [1]
33 participants, five women remained pregnant during the 6-month duration of the study, indicating the importance of addressing prenatal alcohol use for fetal alcohol spectrum disorders (FASD) prevention and focusing on antiretroviral therapy (ART) adherence among women with HIV
The average participant age was older than 30 years, with most having fewer than 12 years of education and having a main partner

Summary

Introduction

South Africa has the largest HIV epidemic globally, with 7.1 million people with HIV and over 20% prevalence among the general population [1]. South Africa has the largest HIV treatment program in the world [1]. HIV-related issues, including HIV acquisition and medication adherence, are often associated with psychosocial factors such as intimate partner violence (IPV) and substance use. The confluence of substance use, violence, and HIV has been labeled the SAVA (substance abuse, violence, and HIV/AIDS). Women of historically underserved racial/ethnic groups are represented disproportionately in this syndemic, demonstrating how these intersectional issues affect women and that each issue cannot be addressed as a single solution [2]. The syndemic of prenatal alcohol use, IPV, and HIV is common in South

Methods

Results

Conclusion