title: Longitudinal adherence to antiretroviral drugs for preventing mother-to-child transmission of HIV in Zambia.
abstract: BACKGROUND
  Adherence to antiretroviral (ARV) drugs is essential for eliminating new pediatric infections of human immunodeficiency virus (HIV). Since the Zambian government revised the national guidelines based on option A (i.e., maternal zidovudine and infant ARV prophylaxis) of the World Health Organization's 2010 guidelines, no studies have assessed adherence to ARVs during pregnancy up to the postpartum period. This study aimed to examine adherence to ARVs and identify the associated risk factors.
  
  
  METHODS
  A prospective cohort study was conducted in the Chongwe district from June 2011 to January 2014. Self-reported adherence to ARVs was examined during pregnancy and at one week, six weeks, and 24 weeks postpartum among 321 HIV-positive women. The probability of remaining adherent to ARVs was estimated using the Kaplan-Meier method, and the risk factors for non-adherence were identified using the Cox proportional hazard regressions--treating loss to follow-up as non-adherence. The statuses of HIV in HIV-exposed infants were assessed in January 2014.
  
  
  RESULTS
  During the study period, 326 infants were born to HIV-positive women, 262 (80.4%) underwent HIV testing, and 11 (3.4%) had their HIV infection detected at the time that they had the latest HIV testing as of January 2014. The ARV adherence rate was 82.5% during pregnancy, 84.2% at one week postpartum, 81.5% at six weeks postpartum, and 70.5% at 24 weeks postpartum. The probability of remaining adherent to ARVs was 0.61 at day 50, 0.35 at day 100, 0.18 at day 200, and 0.06 at day 300. Attending a referral health center (HC) was a risk factor for non-adherence compared with attending rural HCs that provided HIV care/treatment (adjusted hazard ratio [aHR] 0.71, 95% confidence interval [CI] 0.57-0.88) and those that did not provide HIV care/treatment (aHR 0.58, 95% CI 0.46-0.74). A new diagnosis of HIV infection compared to a known HIV-positive status before pregnancy was another risk factor for non-adherence (aHR 1.24, 95% CI 1.03-1.50).
  
  
  CONCLUSIONS
  Maintaining adherence to ARVs through pregnancy to the postpartum period remains a crucial challenge in Zambia. To maximize the treatment benefits, adherence to ARVs and retention in care should be improved at all health facilities.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. sumiyo@m.u-tokyo.ac.jp.
authors.forename: Sumiyo
authors.initials: S
authors.lastname: Okawa
authors.affiliation: Chongwe District Community Health Office, Chongwe, Zambia. chirwamable@yahoo.com.|Ministry of Health Zambia-Japan International Cooperation Agency SHIMA project, Lusaka, Zambia. chirwamable@yahoo.com.
authors.forename: Mable
authors.initials: M
authors.lastname: Chirwa
authors.affiliation: National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. n-ishikawa@it.ncgm.go.jp.
authors.forename: Naoko
authors.initials: N
authors.lastname: Ishikawa
authors.affiliation: Chongwe District Community Health Office, Chongwe, Zambia. kapyata2012@gmail.com.|Ministry of Health Zambia-Japan International Cooperation Agency SHIMA project, Lusaka, Zambia. kapyata2012@gmail.com.
authors.forename: Henry
authors.initials: H
authors.lastname: Kapyata
authors.affiliation: Chongwe District Community Health Office, Chongwe, Zambia. myekha@yahoo.com.|Ministry of Health Zambia-Japan International Cooperation Agency SHIMA project, Lusaka, Zambia. myekha@yahoo.com.
authors.forename: Charles Yekha
authors.initials: CY
authors.lastname: Msiska
authors.affiliation: Ministry of Health, Lusaka, Zambia. gsyakantu@yahoo.com.
authors.forename: Gardner
authors.initials: G
authors.lastname: Syakantu
authors.affiliation: National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. s-miyano@it.ncgm.go.jp.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyano
authors.affiliation: Ministry of Health Zambia-Japan International Cooperation Agency SHIMA project, Lusaka, Zambia. k-komada@it.ncgm.go.jp.|National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. k-komada@it.ncgm.go.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komada
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. mjimba@m.u-tokyo.ac.jp.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. jyasuoka@m.u-tokyo.ac.jp.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000627:therapeutic use; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011336:Probability; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data; D057566:Self Report; D013997:Time Factors; D055815:Young Adult; D015024:Zambia; D015215:Zidovudine / Q000627:therapeutic use; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine