Adherence to antiretroviral therapy during pregnancy and the first year postpartum among HIV-positive women in Ukraine

BMC Public Health

Mario Cortina-Borja²  Igor Semenenko¹  Claire L Townsend²  Ruslan Malyuta¹  Claire Thorne²  Heather Bailey² 

[1] Perinatal Prevention of AIDS Initiative, Odessa, Ukraine;Population Policy and Practice Programme, UCL Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK

关键词: Prevention of mother-to-child transmission;    Pregnancy;    Women;    Eastern Europe;    Ukraine;    Self-efficacy;    Adherence;    Antiretroviral therapy;    HIV;   

Others  :  1126679
DOI  :  10.1186/1471-2458-14-993

 received in 2014-02-27, accepted in 2014-09-18,  发布年份 2014

【 摘 要 】

Background

Poor adherence to antiretroviral therapy (ART) is associated with HIV disease progression and, during pregnancy, increased mother-to-child transmission risk. In Ukraine, access to combination ART is expanding but data on adherence are scarce.

Methods

Cross-sectional surveys of HIV-positive women were conducted i) at delivery (on antenatal ART adherence) and ii) during the first year postpartum (on ART adherence in the preceding four weeks). Factors associated with a score ≤11 on the self-report Case Adherence Support Evaluation (CASE) index or ≥1 self-reported missed dose were assessed using Fisher’s exact test.

Results

Of 185 antenatal participants and 102 postnatal participants, median ages were 27.5 and 29.5 years respectively: 28% (50/180) and 27% (26/98) reported an unplanned pregnancy, and 13% (24/179) and 17% (17/98) an illicit drug-use history (excluding marijuana). One quarter (49/180 antenatally, 27/101 postnatally) screened positive for depression. The proportion reporting ‘low’ ART-related self-efficacy (i.e. unable to do ≥1/5 ART-taking activities) was 20% (28/141) antenatally and 17% (11/66) postnatally. Antenatally, 14% (95% CI 10-21%) had a CASE score ≤11 and 35% (95% CI 28-42%) reported missing ≥1 dose. Factors associated with a CASE score ≤11 were unplanned pregnancy (25% (12/48) vs. 11% (13/120) where planned, p = 0.03) and living with extended family (23% (13/57) vs. 10% (12/125) living with partner/alone, p = 0.04). Self-report of ≥1 missed dose antenatally was additionally associated with younger age (p = 0.03) and lower self-efficacy (50% (14/28) reported ≥1 missed dose vs. 28% (30/108) of those with high self-efficacy, p = 0.04). Of 102 postnatal participants, 8% (95% CI 4-15%) had a CASE score ≤11 and 31% (95% CI 22-41%) reported ≥1 missed dose. Of 11 women with low self-efficacy, 3 (27%) had a CASE score ≤11 compared with 3/55 (5%) of those with high self-efficacy (p = 0.05). Current smokers more commonly reported ≥1 missed dose postnatally (50% (13/26) vs. 25% (18/72) of non-smokers, p = 0.03).

Conclusions

Our results highlight unmet needs for counselling and support. We identify some groups at risk of poor ART adherence, including women with markers of social vulnerability and those with low ART-related self-efficacy, who may benefit from targeted interventions.

【 授权许可】

   
2014 Bailey et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]WHO, UNAIDS, UNICEF: Global HIV/AIDS Response. Epidemic Update and Health Sector Progress towards Universal Access. Progress Report 2011. 2011.
• [2]UNAIDS: UNAIDS report on the global AIDS epidemic 2013. 2013. Available at http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf webcite (accessed September 2014)
• [3]Ministry of Health of Ukraine: Ukraine Harmonized AIDS Response Progress Report. Reporting Period: January 2010 - December 2011. Kiev, Ukraine: Ministry of Health of Ukraine; 2012.
• [4]WHO: Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Their Infants: Recommendations for a Public Health Approach. 2010 Version. Geneva, Switzerland: World Health Organization; 2010.
• [5]Bailey H, Townsend CL, Semenenko I, Malyuta R, Cortina-Borja M, Thorne C, Ukraine European Collaborative Study Group in E: Impact of expanded access to combination antiretroviral therapy in pregnancy: results from a cohort study in Ukraine. Bull World Health Organ 2013, 91(7):491-500.
• [6]Ministry of Health of Ukraine: Ukraine: National Report on Monitoring Progress Towards the UNGASS Declaration of Commitment on HIV/AIDS, January 2008-December 2009. Kiev: Ministry of Health of Ukraine; 2010.
• [7]Gross R, Yip B, Lo Re V III, Wood E, Alexander CS, Harrigan PR, Bangsberg DR, Montaner JSG, Hogg RS: A simple dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression. J Infect Dis 2006, 194:1108-1114.
• [8]Lima VD, Harrigan R, Murray M, Moore DM, Wood E, Hogg RS, Montaner JSG: Differential impact of adherence on long-term treatment response among naive HIV-infected individuals. AIDS 2008, 22:2371-2380.
• [9]Lima VD, Harrigan R, Bangsberg DR, Hogg RS, Gross R, Yip B, Montaner JSG: The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr 2009, 50(5):529-536.
• [10]Warszawski J, Tubiana R, Le Chenadec J, Blanche S, Teglas JP, Dollfus C, Faye A, Burgard M, Rouzioux C, Mandelbrot L, ANRS French Perinatal Cohort: Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS french perinatal cohort. AIDS 2008, 22(2):289-299.
• [11]Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA: Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 2008, 22(8):973-981.
• [12]Desai N, Mathur M: Selective transmission of multidrug resistant HIV to a newborn related to poor maternal adherence. Sex Transm Infect 2003, 79:419-421.
• [13]Mellins CA, Chu C, Malee K, Allison S, Smith R, Harris L, Higgins A, Zorrilla C, Landesman S, Serchuck L, Larussa P: Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women. AIDS Care 2008, 20(8):958-968.
• [14]Cohn SE, Umbleja T, Mrus J, Bardeguez AD, Andersen JW, Chesney MA: Prior illicit drug use and missed prenatal vitamins predict nonadherence to antiretroviral therapy in pregnancy: adherence analysis A5084. AIDS Patient Care STDS 2008, 22(1):29-40.
• [15]Kingston MA, Letham CJ, McQuillan O: Adherence to antiretroviral therapy in pregnancy. Int J STD AIDS 2007, 18(11):787-789.
• [16]Turner BJ, Newschaffer CJ, Zhang D, Cosler L, Hauck WW: Antiretroviral Use and pharmacy-based measurement of adherence in postpartum HIV-infected women. Med Care 2000, 38(9):911-925.
• [17]Laine C, Newschaffer CJ, Zhang D, Cosler L, Hauck WW, Turner BJ: Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: a pharmacy claims-based analysis. Obstet Gynecol 2000, 95(2):167-173.
• [18]Minozzi S, Amato L, Vecchi S, Davoli M: Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database Syst Rev 2008, 16(2):CD006318.
• [19]Judice N, Zaglada O, Mbuya-Brown R: HIV Policy Assessment: Ukraine. Washington, DC: Futures Group, Health Policy Project; 2011.
• [20]Nachega JB, Uthman OA, Anderson J, Peltzer K, Wampold S, Cotton MF, Mills EJ, Ho YS, Stringer JS, McIntyre JA, Mofenson LM: Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS 2012, 26(16):2039-2052.
• [21]Vaz MJ, Barros SM, Palacios R, Senise JF, Lunardi L, Amed AM, Castelo A: HIV-infected pregnant women have greater adherence with antiretroviral drugs than non-pregnant women. Int J STD AIDS 2007, 18:28-32.
• [22]Bardeguez AD, Lindsey JC, Shannon M, Tuomala RE, Cohn SE, Smith E, Stek A, Buschur S, Cotter A, Bettica L, Read JS: Adherence to antiretrovirals among US women during and after pregnancy. J Acquir Immune Defic Syndr 2008, 48(4):408-417.
• [23]Ickovics JR, Wilson TE, Royce RA, Minkoff HL, Fernandez MI, Fox-Tierney R, Koenig LJ: Prenatal and postpartum zidovudine adherence among pregnant women with HIV: results of a MEMS substudy from the Perinatal Guidelines Evaluation Project. J Acquir Immune Defic Syndr 2002, 30(3):311-315.
• [24]Bailey H, Thorne C, Semenenko I, Malyuta R, Tereschenko R, Adeyanova I, Kulakovskaya E, Ostrovskaya L, Kvasha L, Cortina-Borja M, Townsend CL: Cervical screening within HIV care: findings from an HIV-positive cohort in Ukraine. PLoS One 2012, 7(4):e34706.
• [25]AIDS Clinical Trials Group: Center for AIDS prevention studies (CAPS) instruments: ACTG adherence baseline questionnaire. 2010. Accessed September 2012. http://caps.ucsf.edu/uploads/tools/surveys/pdf/2098.4186.pdf webcite
• [26]NIAID Adult AIDS Clinical Trials Group: Supplemental antepartum adherence questionnaire. 2001. Accessed August 2014. Available at https://www.fstrf.org/apps/cfmx/apps/common/QOLAdherenceForms/index.cfm?project=ACTG webcite
• [27]Mannheimer SB, Mukherjee R, Hirschhorn LR, Dougherty J, Celano SA, Ciccarone D, Graham KK, Mantell JE, Mundy LM, Eldred L, Botsko M, Finkelstein R: The CASE adherence index: a novel method for measuring adherence to antiretroviral therapy. AIDS Care 2006, 18(7):853-861.
• [28]Kerr SJ, Avihingsanon A, Putcharoen O, Chetchotisakd P, Layton M, Ubolyam S, Ruxrungtham K, Cooper DA, Phanuphak P, Duncombe C: Assessing adherence in Thai patients taking combination antiretroviral therapy. Int J STD AIDS 2012, 23(3):160-165.
• [29]Apisarnthanarak A, Mundy LM: Application of a 3-item adherence metric to monitor antiretroviral medication adherence in a resource-limited setting. J Acquir Immune Defic Syndr 2010, 55(4):528.
• [30]Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA: Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav 2006, 10:227-245.
• [31]Whooley MA, Avins AL, Miranda J, Browner WS: Case-finding instruments for depression: two questions are as good as many. J Gen Intern Med 1997, 12:439-445.
• [32]Arroll B, Goodyear-Smith F, Kerse N, Fishman T, Gunn J: Effect of the addition of a “help” question to two screening questions on specificity for diagnosis of depression in general practice: diagnostic validity study. BMJ 2005, 331(7521):884.
• [33]AIDS Clinical Trials Group: Center for AIDS Prevention Studies (CAPS) instruments: the HIV treatment adherence self-efficacy scale. 2010. Accessed September 2012. http://caps.ucsf.edu/uploads/tools/surveys/pdf/HIV-ASES.pdf webcite
• [34]Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG: Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009, 42(2):377-381.
• [35]Bangsberg DR, Hecht FM, Charlebois ED, Zolopa A, Holodniy M, Sheiner L, Bamberger JD, Chesney MA, Moss A: Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS 2000, 14:357-366.
• [36]Liu H, Golin CE, Miller LG, Hays RD, Beck CK, Sanandaji S, Christian JMT, Duran D, Kaplan AH, Wenger NS: A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med 2001, 134:968-977.
• [37]Kimmerling M, Wagner G, Ghosh-Dastidar B: Factors associated with accurate self-reported adherence to HIV antiretrovirals. Int J STD AIDS 2003, 14:281-284.
• [38]WHO: Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva, Switzerland: World Health Organisation; 2013.
• [39]Ahmed S, Kim MH, Abrams EJ: Risks and benefits of lifelong antiretroviral treatment for pregnant and breastfeeding women: a review of the evidence for the Option B + approach. Curr Opin HIV AIDS 2013, 8(5):474-489.
• [40]El-Khatib Z, Ekstrom AM, Coovadia A, Abrams EJ, Petzold M, Katzenstein D, Morris L, Kuhn L: Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study. BMC Public Health 2011, 11:88. BioMed Central Full Text
• [41]Sherr L, Lampe FC, Clucas C, Johnson M, Fisher M, Leake Date H, Anderson J, Edwards S, Smith CJ, Hill T, Harding R: Self-reported non-adherence to ART and virological outcome in a multiclinic UK study. AIDS Care 2010, 22(8):939-945.
• [42]Sabin CA, Smith CJ, d’Arminio Monforte A, Battegay M, Gabiano C, Galli L, Geelen S, Gibb D, Guiguet M, Judd A, Leport C, Dabis F, Pantazis N, Porter K, Raffi F, Thorne C, Torti C, Walker S, Warszawski J, Wintergerst U, Chene G, Lundgren J: Response to combination antiretroviral therapy: variation by age. AIDS 2008, 22(12):1463-1473.
• [43]Hadland SE, Milloy MJ, Kerr T, Zhang R, Guillemi S, Hogg RS, Montaner JS, Wood E: Young age predicts poor antiretroviral adherence and viral load suppression among injection drug users. AIDS Patient Care STDS 2012, 26(5):274-280.
• [44]Palipudi KM, Gupta PC, Sinha DN, Andes LJ, Asma S, McAfee T, Group GC: Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from Global Adult Tobacco Survey. PLoS One 2012, 7(3):e33466.
• [45]Ironson G, Weiss S, Lydston D, Ishii M, Jones D, Asthana D, Tobin J, Lechner S, Laperriere A, Schneiderman N, Antoni M: The impact of improved self-efficacy on HIV viral load and distress in culturally diverse women living with AIDS: the SMART/EST Women’s Project. AIDS Care 2005, 17(2):222-236.
• [46]Jones DL, Ishii Owens M, Lydston D, Tobin JN, Brondolo E, Weiss SM: Self-efficacy and distress in women with AIDS: the SMART/EST women’s project. AIDS Care 2010, 22(12):1499-1508.
• [47]Johnston Roberts K, Volberding P: Adherence communication: a qualitative analysis of physician-patient dialogue. AIDS 1999, 13:1771-1778.
• [48]Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, Kaplan AH, Wenger NS: A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med 2002, 17:756-765.