Determinants of suboptimal adherence and elevated HIV viral load in pregnant women already on antiretroviral therapy when entering antenatal care in Cape Town, South Africa

Bibliographic Data

ID19439912
AuthorsKirsty Brittain (0000-0003-3940-1242, University of Cape Town, corresponding author), Robert H Remien (0000-0002-3963-3273, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA), Claude Ann Mellins (0000-0002-1978-7638, Columbia University), Tamsin K Phillips (0000-0003-4554-2922, University of Cape Town), Allison Zerbe (0000-0002-3372-6882, ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA), Elaine J Abrams (0000-0001-7938-8981, ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA), Landon Myers (0000-0002-8106-7658, University of Cape Town), Landon Myer (University of Cape Town)
Year2018
Volume30
Issue12
Pages1517-1523
Publication date2018-12-02
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2018.1503637
PMID30047287
OpenAlexW2883201855
LanguageEN
Citations received9
References cited23

Across sub-Saharan Africa, prevention of mother-to-child transmission services are encountering increasing numbers of women already established on antiretroviral therapy (ART) when entering antenatal care. However, there are few data examining ART adherence and HIV viral load in this group. We used multivariable logistic regression models to examine self-reported suboptimal adherence (defined as missed ART doses on ≥2 days during the preceding 30 days), elevated viral load (≥1000 copies/mL), and factors associated with each among women entering antenatal care on ART. Participants were recruited from one primary care clinic in Gugulethu, Cape Town, as part of a larger study of HIV-positive pregnant and postpartum women. Among 482 pregnant women established on ART and enrolled between May 2013 and June 2014 (median age: 31 years; median duration of ART use: 3 years), 15% reported suboptimal adherence and 12% had elevated viral load. After adjustment for age, suboptimal adherence was significantly more common among women who were not married/cohabiting and women who reported a higher level of concern about taking ART; a higher level of adherence self-efficacy was associated with a reduced odds of suboptimal adherence. In a multivariable model, elevated viral load was significantly associated with previous discontinuation of ART, a higher level of concern about taking ART, and report of an unintended pregnancy. Suboptimal adherence and elevated viral load are common among women entering antenatal care already on ART. Our findings highlight specific beliefs and concerns about ART use during pregnancy that should be addressed in counselling messaging, and suggest that family planning should be more effectively integrated into HIV care. Including adherence and viral load monitoring as part of pregnancy planning for women on ART may be important to achieve safer conception and promote healthy pregnancies

Antiretroviral therapy · Discontinuation · Family medicine · Logistic regression · Obstetrics · Odds · Odds ratio · Pregnancy · Viral load · Adolescent Sexual and Reproductive Health · Global Maternal and Child Health · HIV/AIDS Research and Interventions · Medicine · Internal Medicine · Pediatrics