Long-term postpartum adherence to antiretroviral drugs among women in Latin America.
Antiretroviral adherence in the postpartum period is crucial for maternal health and decreasing the risk of mother-to-child HIV transmission and transmission to sexual partners. Self-reported antiretroviral adherence was examined between 6- to 12-weeks and 30 months postpartum among 270 HIV-infected women enrolled in a prospective cohort study from 2008 to 2010 at multiple sites in Latin America. Adherence data were collected at each study visit to quantify the proportion of prescribed antiretrovirals taken during the previous three days, assess the timing of the last missed dose, and identify predictors of adherence. Mean adherence rates were 89.5% at 6-12 weeks and 92.4% at 30 months; the proportions with perfect adherence were 80.3% and 83.6%, respectively. The overall trend for perfect adherence was not significant (p = 0.71). In adjusted regression modelling, younger age was associated with an increased probability of non-perfect adherence at 18 and 24 months postpartum. Other factors associated with increased probability of non-perfect adherence were higher parity, current use of alcohol and tobacco, and more advanced HIV disease. Women with perfect adherence had lower viral loads. Interventions for alcohol and tobacco use cessation, and support for young women and those with advanced HIV disease should be considered to improve postpartum adherence.
Irmandade da Santa Casa de Misericordia de Porto Alegre and Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto Alegre, Brazil regis.kr@terra.com.br.
Regis
R
Kreitchmann
Irmandade da Santa Casa de Misericordia de Porto Alegre and Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
Debora Fernandes
DF
Coelho
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Fabiana Maria
FM
Kakehasi
Instituto de Puericultura e Pediatria Martagão Gesteira and Department of Preventive Medicine Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Cristina Barroso
CB
Hofer
Maternal and Pediatric Infectious Disease Branch; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Bethesda, MD, USA; Current affiliation for Dr. Read: National Institute of Allergy and Infectious Diseases; National Institutes of Health, Bethesda, MD, USA.
Jennifer S
JS
Read
Hospital General de Agudos Jose Maria Ramos Mejia, Buenos Aires, Argentina.
Marcelo
M
Losso
Massachusetts General Hospital, Boston, MA, USA.
Jessica E
JE
Haberer
Maternal and Pediatric Infectious Disease Branch; Eunice Kennedy Shriver National Institute of Child Health and Human Development; Bethesda, MD, USA; Current affiliation for Dr. Read: National Institute of Allergy and Infectious Diseases; National Institutes of Health, Bethesda, MD, USA.
George K
GK
Siberry
Westat, Rockville, MD, USA.
D Robert
DR
Harris
Westat, Rockville, MD, USA.
Qilu
Q
Yu
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007843:Latin America; D055118:Medication Adherence / Q000523:psychology; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult; D016903:Drug Monitoring
D019380:Anti-HIV Agents
AIDS; HIV; adherence; antiretroviral; mother-to-child transmission; postpartum; treatment; women