TY - JOUR
T1 - Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era
T2 - 12-month cohort study in urban South Africa and rural Uganda
AU - Matthews, Lynn T.
AU - Orrell, Catherine
AU - Bwana, Mwebesa Bosco
AU - Tsai, Alexander C.
AU - Psaros, Christina
AU - Asiimwe, Stephen
AU - Amanyire, Gideon
AU - Musinguzi, Nicholas
AU - Bell, Kathleen
AU - Bangsberg, David R.
AU - Haberer, Jessica E.
AU - April, Nomakhaya
AU - Mpahleni, Alienah
AU - Situlo, Vivie
AU - Mzamo, Speech
AU - Ngwenya, Nomsa
AU - Panda, Khosi Tshangela Regina
AU - Linda, Teboho
AU - Atwiine, Christine
AU - Moonight, Sheila
AU - Tindimwebwa, Edna
AU - Mugisha, Nicholas
AU - Atwogeire, Peace
AU - Namana, Vian
AU - Kyampaire, Catherine
AU - Nuwagaba, Gabriel
AU - Kembabazi, Annet
AU - Mugisha, Stephen
AU - Nanfuka, Victoria
AU - Cross, Anna
AU - Kelly, Nicky
AU - Moralie, Daphne
AU - Cogill, Dolphina
AU - Ashaba, Justus
AU - Xapa, Zoleka
AU - Orimwesiga, Mathias
AU - Tuhanamagyezi, Elly
AU - Mpanga, Don Bosco
AU - Kyarisima, Leonia
AU - Kigozi, Simone
AU - October, Edgar
AU - Mugisha, Silver
AU - Kiviiri, Ibrahim
AU - Ware, Norma
AU - Elioda, Tumwesigye
AU - Siedner, Mark J.
AU - Katz, Ingrid T.
AU - Wyatt, Monique
N1 - Publisher Copyright:
© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Introduction: We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods: We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression models included demographics and socio-behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV-RNA at 12 months by ever- versus never-pregnant status. Results: In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non-pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm3). HIV-RNA was suppressed among 91% (N = 135) ever-pregnant and 86% (N = 85) never-pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non-pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non-pregnancy-related follow-up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV-RNA was suppressed among 57% (N = 47) ever-pregnant and 86% (N = 93) never-pregnant women. Conclusions: Women in rural Uganda maintained high adherence with 91% of ever-pregnant and 86% of never-pregnant women suppressing HIV-RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow-up with median adherence of 40% and 57% of women with HIV-RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.
AB - Introduction: We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. Methods: We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression models included demographics and socio-behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV-RNA at 12 months by ever- versus never-pregnant status. Results: In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non-pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm3). HIV-RNA was suppressed among 91% (N = 135) ever-pregnant and 86% (N = 85) never-pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non-pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non-pregnancy-related follow-up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV-RNA was suppressed among 57% (N = 47) ever-pregnant and 86% (N = 93) never-pregnant women. Conclusions: Women in rural Uganda maintained high adherence with 91% of ever-pregnant and 86% of never-pregnant women suppressing HIV-RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow-up with median adherence of 40% and 57% of women with HIV-RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.
KW - ARV
KW - ARV
KW - Africa < Region
KW - Africa < Region
KW - Cohort studies
KW - HIV
KW - HIV
KW - adherence
KW - adherence
KW - cohort studies
KW - gender
KW - gender
KW - women
KW - women
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U2 - 10.1002/jia2.25586
DO - 10.1002/jia2.25586
M3 - Article
C2 - 32820622
AN - SCOPUS:85089769650
SN - 1758-2652
VL - 23
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 8
M1 - e25586
ER -