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 - Funding Information:
This work was supported by the Bill & Melinda Gates Foundation (grant OPP113634). The funder had no role in study design, data gathering, analysis and interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. An earlier analysis of these data was presented in 2018 at the Conference on Retroviruses and Opportunistic Infections (CROI). LTM and ACT involved in study design, analysis, interpretation and manuscript writing. CO, MBB, GA and SA carried out study design, data collection, interpretation and manuscript review. CP and KB involved in interpretation and manuscript review. KB also contributed to data collection. NM performed analysis and manuscript drafting. DRB involved in study design and manuscript review. JEH contributed to study design, analysis, interpretation and manuscript review. All authors have read and approved the final manuscript. We thank all study participants for their time and involvement in the study, and we thank the study staff, including the following: research assistants. Nomakhaya April, R.N., Alienah Mpahleni, Vivie Situlo, Speech Mzamo, Nomsa Ngwenya, Khosi Tshangela Regina Panda, Teboho Linda, Christine Atwiine, Sheila Moonight, Edna Tindimwebwa, Nicholas Mugisha, Peace Atwogeire, Vian Namana, Catherine Kyampaire and Gabriel Nuwagaba; programme managers, Annet Kembabazi, Stephen Mugisha, Victoria Nanfuka, Anna Cross, Nicky Kelly, Daphne Moralie and K.B.; statistician, N. M.; data managers, Dolphina Cogill, Justus Ashaba, Zoleka Xapa, Mathias Orimwesiga, Elly Tuhanamagyezi and Catherine Kyampaire; laboratory managers, Don Bosco Mpanga, Leonia Kyarisima and Simone Kigozi and drivers, Edgar October, Silver Mugisha and Ibrahim Kiviiri. META Study Investigators. The Monitoring of Early Treatment Adherence (META) study team includes, as principal investigators, J.E.H., C.O., Norma Ware, M.B.B., S.A., G.A., Tumwesigye Elioda and D.R.B.; and as coinvestigators, A.C.T., Mark J Siedner, L.T.M., Ingrid T Katz and Monique Wyatt. This work was supported by the Bill & Melinda Gates Foundation (grant OPP113634). The funder had no role in study design, data gathering, analysis and interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. An earlier analysis of these data was presented in 2018 at the Conference on Retroviruses and Opportunistic Infections (CROI).
Funding Information:
This work was supported by the Bill & Melinda Gates Foundation (grant OPP113634). The funder had no role in study design, data gathering, analysis and interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. An earlier analysis of these data was presented in 2018 at the Conference on Retroviruses and Opportunistic Infections (CROI).
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 -