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\xa0months after initiating option B+

Michael Hoelscher,Pascal N. Atanga,Harrison T. Ndetan,Arne Kroidl,Tih P. Muffih,Eric A. Achidi,Henry D. Meriki,Peter N. Fon

doi:10.1186/s12884-018-2058-9

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.

Highlights

Antiretroviral therapy (ART) adherence in preventing Human Immunodeficiency Virus (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
During the first year of Option B+ implementation in Cameroon our novel composite adherence score (CAS) adherence tool was feasible, and useful to discriminate ART adherence levels which correlated with viral suppression
We further investigated risk factors associated with poor adherence alongside enablers of proper drug taking behaviour

Summary

Introduction

Antiretroviral 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. Adherence to antiretroviral therapy (ART) for HIV infection is essential for plasma viral load suppression This is key to treatment success as it reduces both morbidity and mortality but most importantly improves the quality of life and reduces drug resistance development [1,2,3]. Viral load (VL) suppression data can provide additional information to improve adherence assessment conducted using any subjective measure, though it could be affected by pre-treatment HIV drug resistance [18]. Sub-optimal adherence needs to be identified and addressed early prior to treatment failure and the development of viral drug resistance This is possible only if we understand the risk factors of poor adherence and those enablers of proper medication taking behaviour. Notwithstanding the importance of near perfect adherence on viral suppression, recent research findings are showing that newer ART regimens may only require moderate adherence levels to achieve viral suppression [22,23,24]

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