A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy.
Maternal adherence to antiretroviral therapy (ART) is a concern and monitoring adherence presents a significant challenge in low-resource settings. We investigated the association between self-reported adherence, measured using a simple three-item scale, and elevated viral load (VL) among HIV-infected pregnant and postpartum women on ART in Cape Town, South Africa. This is the first reported use of this scale in a non-English speaking setting and it achieved good psychometric characteristics (Cronbach α = 0.79). Among 452 women included in the analysis, only 12 % reported perfect adherence on the self-report scale, while 92 % had a VL <1000 copies/mL. Having a raised VL was consistently associated with lower median adherence scores and the area under the curve for the scale was 0.599, 0.656 and 0.642 using a VL cut-off of ≥50, ≥1000 and ≥10000 copies/mL, respectively. This simple self-report adherence scale shows potential as a first-stage adherence screener in this setting. Maternal adherence monitoring in low resource settings requires attention in the era of universal ART, and the value of this simple adherence scale in routine ART care settings warrants further investigation.
Division of Epidemiology & Biostatistics, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. tk.phillips@uct.ac.za.
Tamsin
T
Phillips
Division of Epidemiology & Biostatistics, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Kirsty
K
Brittain
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Claude A
CA
Mellins
ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
Allison
A
Zerbe
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Robert H
RH
Remien
ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.|College of Physicians & Surgeons, Columbia University, New York, NY, USA.
Elaine J
EJ
Abrams
Division of Epidemiology & Biostatistics, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
Landon
L
Myer
Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
Ira B
IB
Wilson
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006295:Health Resources; D006801:Humans; D055118:Medication Adherence; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D037841:Pregnant People; D011594:Psychometrics; D057566:Self Report; D013019:South Africa; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents
Adherence; Maternal antiretroviral therapy; Psychometric scale; Self-report; South Africa; Viral load