title: Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi's Option B+ Program.
abstract: Adherence to antiretroviral therapy (ART) is crucial to preventing mother-to-child transmission of human immunodeficiency virus (HIV) and ensuring the long-term effectiveness of ART, yet data are sparse from African routine care programs on maternal adherence to triple ART.
  
  
  
  We analyzed data from women who started ART at 13 large health facilities in Malawi between September 2011 and October 2013. We defined adherence as the percentage of days "covered" by pharmacy claims. Adherence of ≥90% was deemed adequate. We calculated inverse probability of censoring weights to adjust adherence estimates for informative censoring. We used descriptive statistics, survival analysis, and pooled logistic regression to compare adherence between pregnant and breastfeeding women eligible for ART under Option B+, and nonpregnant and nonbreastfeeding women who started ART with low CD4 cell counts or World Health Organization clinical stage 3/4 disease.
  
  
  
  Adherence was adequate for 73% of the women during pregnancy, for 66% in the first 3 months post partum, and for about 75% during months 4-21 post partum. About 70% of women who started ART during pregnancy and breastfeeding adhered adequately during the first 2 years of ART, but only about 30% of them had maintained adequate adherence at every visit. Risk factors for inadequate adherence included starting ART with an Option B+ indication, at a younger age, or at a district hospital or health center.
  
  
  
  One-third of women retained in the Option B+ program adhered inadequately during pregnancy and breastfeeding, especially soon after delivery. Effective interventions to improve adherence among women in this program should be implemented.
authors.affiliation: Institute of Social & Preventive Medicine.
authors.forename: Andreas D
authors.initials: AD
authors.lastname: Haas
authors.affiliation: Institute of Social & Preventive Medicine The Baobab Health Trust.
authors.forename: Malango T
authors.initials: MT
authors.lastname: Msukwa
authors.affiliation: Institute of Social & Preventive Medicine Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa.
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.affiliation: Institute of Social & Preventive Medicine International Training & Education Center for Health.
authors.forename: Lyson
authors.initials: L
authors.lastname: Tenthani
authors.affiliation: Institute of Social & Preventive Medicine Lighthouse Trust The International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.affiliation: International Training & Education Center for Health Department of HIV and AIDS, Ministry of Health, Lilongwe.
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahn
authors.affiliation: The Baobab Health Trust.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Gadabu
authors.affiliation: Institute of Social & Preventive Medicine.
authors.forename: Kali
authors.initials: K
authors.lastname: Tal
authors.affiliation: Institute of Social & Preventive Medicine Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Luisa
authors.initials: L
authors.lastname: Salazar-Vizcaya
authors.affiliation: Institute of Social & Preventive Medicine.
authors.forename: Janne
authors.initials: J
authors.lastname: Estill
authors.affiliation: Institute of Social & Preventive Medicine.
authors.forename: Adrian
authors.initials: A
authors.lastname: Spoerri
authors.affiliation: Institute of Social & Preventive Medicine.
authors.forename: Nozgechi
authors.initials: N
authors.lastname: Phiri
authors.affiliation: Department of HIV and AIDS, Ministry of Health, Lilongwe.
authors.forename: Frank
authors.initials: F
authors.lastname: Chimbwandira
authors.affiliation: Dignitas International, Zomba Department of Medicine, College of Medicine, University of Malawi, Blantyre.
authors.forename: Joep J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.affiliation: Institute of Social & Preventive Medicine.
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008295:Malawi; D008297:Male; D055118:Medication Adherence; D009313:National Health Programs; D011181:Postnatal Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; Option B+; adherence; antiretroviral therapy; mother-to-child-transmission