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Home >> Publications >> Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi's Option B+ Program

Publication

Author(s):

Haas AD1, Msukwa MT2, Egger M3, Tenthani L4, Tweya H5, Jahn A6, Gadabu OJ7, Tal K1, Salazar-Vizcaya L8, Estill J1, Spoerri A1, Phiri N1, Chimbwandira F9, van Oosterhout JJ10, Keiser O1.

Pub Title:

Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi's Option B+ Program

Pub Date:

Jul 26 2016

Pub Region(s):

Southern Africa

Journal:

Title: 
Clin Infect Dis.
Link: 
http://cid.oxfordjournals.org/content/early/2016/08/19/cid.ciw500.long

PubMed: 27461920
Pub PDF:

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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Citation:

Clin Infect Dis. 2016 Jul 26. pii: ciw500. [Epub ahead of print] Adherence to Antiretroviral Therapy During and After Pregnancy: Cohort Study on Women Receiving Care in Malawi's Option B+ Program. Haas AD1, Msukwa MT2, Egger M3, Tenthani L4, Tweya H5, Jahn A6, Gadabu OJ7, Tal K1, Salazar-Vizcaya L8, Estill J1, Spoerri A1, Phiri N1, Chimbwandira F9, van Oosterhout JJ10, Keiser O1.