Self-Reported Long-Term Antiretroviral Adherence: A Longitudinal Study Among HIV Infected Pregnant Women in Mpumalanga, South Africa

Sibusiso Sifunda,Karl Peltzer,Shandir Ramlagan,Robert A. C. Ruiter,Deborah L. Jones,Violeta J. Rodriguez

doi:10.1007/s10461-019-02563-z

Abstract

We evaluate the impact of a multi-session cognitive behavioral prevention of mother to child transmission (PMTCT) intervention on antiretroviral therapy (ART) adherence. A total of 683 women were enrolled into a randomized control trial conducted at twelve community health centres (CHCs) in Mpumalanga Province. Participants were randomized to Standard Care or Enhanced PMTCT Intervention (EI). EI received three group and three individual intervention sessions. EI impact was ascertained on ART adherence (baseline vs 12 months post-partum). Women in the intervention groups were less likely to remain stable with regards to ART adherence over time compared to the control groups. In predicting if women become adherent over time, the intervention condition had no impact. However, the intervention condition was significantly positively associated with change to non-adherence. The enhanced cognitive-behavioral PMTCT intervention did not show any improvement in relation to maternal ART adherence relative to standard PMTCT care.Trial registration Clinicaltrials.gov: number NCT02085356.

Highlights

Women who are pregnant and living with Human Immunodeficiency Virus (HIV) are recognised as part of the HIV key and vulnerable population group [1, 2]
The study found that the enhanced intervention had no desired effect on antiretroviral therapy (ART) adherence over time
The high loss to follow up and limited post-partum ART adherence intervention could have led to this outcome

Summary

Introduction

Women who are pregnant and living with Human Immunodeficiency Virus (HIV) are recognised as part of the HIV key and vulnerable population group [1, 2]. Antiretroviral therapy (ART) is recommended for HIV infected women for viral suppression and reduction of perinatal HIV transmission [3, 4]. It is not the provision of the ART that is recommended and the adherence regimen associated with ART. In this case, adherence to ART is defined as patients taking their medication as prescribed, as even minor deviations from this regimen can be detrimental to maternal and neonatal health [5]. Longitudinal studies in Argentina, Brazil, Peru [4] and in Switzerland [5] found that self-reported adherence among HIV infected pregnant women decreased significantly post-partum

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