Abstract
IntroductionPregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery. We quantified changes in priorities related to isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) among pregnant women living with HIV.MethodsWe enrolled pregnant women recently diagnosed with HIV from 14 primary health clinics during pregnancy and followed them after delivery in Matlosana, South Africa. Best–worst scaling (BWS) was used to determine the women's priorities out of 11 attributes related to preventive therapy in the ante‐ versus postpartum periods. Aggregate BWS scores were calculated based on the frequency with which participants selected each attribute as the best or worst among five options (across multiple choice sets). Individual BWS scores were also calculated and rescaled from 0 (always selected as worst) to 10 (always selected as best), and changes in BWS scores in the ante‐ versus postpartum periods were compared, using a paired t‐test. Factors associated with the changes in BWS scores were examined in multiple linear regressions. Spearman's rho was used to compare the ranking of attributes.ResultsOut of a total of 204 participants, 154 (75.5%) completed the survey in the postpartum at the median 15 (IQR: 11 to 27) weeks after delivery. Trust in healthcare providers was most highly prioritized both in the ante‐ (individual BWS Score = 7.34, SE = 0.13) and postpartum periods (BWS = 7.21 ± 0.11), followed by living a long life (BWS = 6.77 ± 0.09 in the ante‐ vs. BWS = 6.86 ± 0.10 in the postpartum). Prevention for infants’ health was more prioritized in the post‐ (BWS = 6.54 ± 0.09) versus antepartum periods (BWS = 6.11 ± 0.10) (p = 0.05). This change was associated with IPT initiation at enrolment (regression coefficient = 0.78 ± 0.33, p = 0.001). Difficulty in daily pill‐uptake was significantly more prioritized in the postpartum (BWS = 5.03 ± 0.11) than in the antepartum (BWS = 4.43 ± 0.10) (p < 0.01). Transportation cost and worry about side effects of pills were least prioritized. Overall ranking of attributes was similar in both time periods (spearman's rho = 0.90).ConclusionsComprehensive interventions to build trust in healthcare providers and support adherence may increase uptake of preventive therapy. Counselling needs to emphasize medication benefits for both maternal and infant health among HIV‐positive pregnant women.
Highlights
Pregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery
We examined the potential association between individual Best–worst scaling (BWS) scores and clinical factors (CD4 cell counts, isoniazid preventive therapy (IPT) initiation, perceived risk of TB in year and adherence to antiretroviral therapy (ART)) and sociodemographic factors in multiple linear regressions
When individual BWS scores were compared in the antepartum versus postpartum periods, we observed similar patterns
Summary
Pregnant women newly diagnosed with HIV during pregnancy are often lost to follow up and their adherence rates drop after delivery. We quantified changes in priorities related to isoniazid preventive therapy (IPT) and antiretroviral therapy (ART) among pregnant women living with HIV. Prevention for infants’ health was more prioritized in the post- (BWS = 6.54 Æ 0.09) versus antepartum periods (BWS = 6.11 Æ 0.10) (p = 0.05). This change was associated with IPT initiation at enrolment (regression coefficient = 0.78 Æ 0.33, p = 0.001). Antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) are two key interventions to reduce TB incidence and ensure better long-term health outcomes of both HIVpositive pregnant women and their infants [1,6]. When taken together with ART, IPT can decrease the risk of developing
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