Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries

A Systematic Review and Meta-Analysis

Bibliographic Data

ID23372267
AuthorsJean B Nachega (0000-0002-2862-4443, Conference Board, corresponding author), Olalekan Abdulrahman Uthman (0000-0002-8567-3081, Stellenbosch University), Jean Anderson (0000-0002-3280-3225, Johns Hopkins Hospital), Karl Peltzer (0000-0002-5980-0876, Human Sciences Research Council), Sarah Wampold, Mark F Cotton (0000-0003-2559-6034, Stellenbosch University), Edward J Mills (0000-0003-3120-9694, University of Ottawa), Yuh-Shan Ho (0000-0002-2557-8736, Asia University, corresponding author), Jeffrey S A Stringer (0000-0002-9590-7216, Centre for Infectious Disease Research in Zambia), James Mcintyre (0000-0002-9150-1059, University of Cape Town), James A McIntyre, Lynne Mofenson (0000-0002-2818-9808, Eunice Kennedy Shriver National Institute of Child Health and Human Development), Lynne M Mofenson
Year2012
Volume26
Issue16
Pages2039-2052
Publication date2012-10-23
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAIDS (JOURNAL)
Journal identifiersISSN: 0269-9370 • E-ISSN: 1473-5571
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qad.0b013e328359590f
PMID22951634
OpenAlexW2162453519
LanguageEN
Citations received73
References cited90

OBJECTIVE: To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-income, middle-income, and low-income countries. DESIGN: Systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. RESULTS: Of 72 eligible articles, 51 studies involving 20 153 HIV-infected pregnant women were included. Most studies were from United States (n = 14, 27%) followed by Kenya (n = 6, 12%), South Africa (n = 5, 10%), and Zambia (n = 5, 10%). The threshold defining good adherence to ART varied across studies (>80, >90, >95, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% [95% confidence interval (CI) 69.3-77.5%] of pregnant women who had adequate (>80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75.7%, 95% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 32.8-72.7%; P = 0.005). Selected reported barriers for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery), alcohol or drug use, and ART dosing frequency or pill burden. CONCLUSION: Our findings indicate that only 73.5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them is urgently needed globally.

Antiretroviral therapy · Confidence interval · Family medicine · Human immunodeficiency virus (HIV) · MEDLINE · Obstetrics · Pill · Pregnancy · Viral load · Young adult · Demography · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Internal Medicine · Medicine · Mobile Health and mHealth Applications