Compliance with antiretroviral regimens to prevent perinatal HIV-1 transmission in Kenya.
OBJECTIVE
To compare compliance and infant HIV-1 infection risk at 6 weeks with the Thai-CDC and HIVNET-012 antiretroviral regimens in a field setting.


METHODS
Randomized clinical trial.


METHODS
Tertiary hospital antenatal clinic in Nairobi, Kenya.


METHODS
HIV-1 infected women referred from primary care clinics.


METHODS
Thai-CDC zidovudine regimen or HIVNET-012 nevirapine regimen.


METHODS
Women were considered compliant if they used >or= 80% of the doses. Infants were tested for HIV-1 at 6 weeks. RESULTS Seventy women were randomized to Thai-CDC and 69 to HIVNET-012 regimens. More women were compliant with the antenatal (86%) than the intrapartum (44%) Thai-CDC regimen doses ( P= 0.001). Ninety-seven per cent took the maternal and 91% gave the infant dose of the HIVNET-012 regimen (P = 0.2). Overall, 41% were compliant with the Thai-CDC regimen and 87% with the HIVNET-012 regimen ( P< 0.001). Compliance with the Thai-CDC regimen was associated with partner support of antiretroviral use [odds ratio (OR), 3.0;, 95% confidence interval (CI), 1.0-9.1] and knowledge at recruitment that antiretroviral drugs could prevent infant HIV-1 (OR, 2.9; 95% CI, 1.0-8.1). Compliance with the HIVNET-012 regimen was associated with partner notification (OR, 8.0; 95% CI, 1.5-50) and partner willingness to have HIV-1 testing (OR, 7.5; 95% CI, 1.4-40). There was a trend for a higher risk of transmission with the HIVNET-012 regimen than with the Thai-CDC regimen (22% versus 9%; P= 0.07).


CONCLUSIONS
Compliance with the Thai-CDC and HIVNET-012 regimens was comparable to that in efficacy trials. Partner involvement, support and education on perinatal HIV-1 prevention may improve compliance and increase the number of infants protected from HIV-1 infection.
Kiarie
James N
JN
Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Kreiss
Joan K
JK
Richardson
Barbra A
BA
John-Stewart
Grace C
GC
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D017144:Focus Groups; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology / Q000635:transmission; D015497:HIV-1; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000627:therapeutic use; D010349:Patient Compliance; D018579:Patient Selection; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011295:Prenatal Care / Q000379:methods; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine