Adherence to Zidovudine for the Prevention of Perinatal Transmission in HIV-Infected Pregnant Women: The Impact of Social Network Factors, Side Effects, and Perceived Treatment Efficacy

Abstract

Adherence to zidovudine (ZDV) prophylaxis among 78 pregnant HIV-infected women was measured with 2 physiologic markers. Long-term adherence was measured with blood assays for macrocytosis, a clinical indicator of ZDV use; 53 women (67.9%) were adherent. Short-term adherence was measured with urine assays for ZDV; 48 women (61.5%) were adherent. Comparison of urine assay and interview data indicated that 29% had not taken the last dose that they reported. Participation in HIV support groups and disclosure to the participant's mother were associated with better adherence. These social network factors may enable HIV-infected pregnant women to cope more effectively with the multiple stressors they face and facilitate prenatal care.

Maternal-Fetal Attachment and Health Behaviors among Women with HIV/AIDS

“…Adherence to ART among pregnant women diagnosed with HIV/AIDS has been extensively researched in the U.S. Demas et al (2005) found a positive association between progressive gestational age and short-term adherence among a subset of 78 HIVinfected pregnant women participants of the New York City Perinatal HIV Transmission Collaborative Study. Mellins et al (2008) and Bardeguez et al (2008) found that advanced HIV status, higher viral load, more overall health-related symptoms, and alcohol, tobacco or marijuana use were positively associated with medication nonadherence; or negatively associated with "perfect adherence."…”

“…In contrast to the studies reviewed earlier, which examined risk factors or macro-structural barriers for medication adherence, research examining social support, mostly defined as active coping, has led to the identification of protective factors against poor health practices among the population of pregnant women: disclosure of HIV status to women's mothers, participation in support groups, and greater perceived availability of social support (Demas et al, 2005). Less disclosure of their HIV diagnosis to the children and single parent status correlated with missing medical appointments among HIV-infected mothers (Mellins et al, 2003).…”

“…The social support that a woman receives during pregnancy may facilitate access to prenatal care and promote adherence with HIV treatment regimens (Demas et al, 2005;Dunkel-Schetter, et al, 2001). This conclusion is consistent with research findings on social support in the pregnancy literature; specifically, the support a pregnant woman receives from the infant's father most effectively lessens stress, anxiety and depression, and promotes better utilization of prenatal care (Dunkel-Schetter et al, 2001).…”

“…Measures of the marital partner status and the history of substance use variables were included in the maternal-fetal attachment model because they capture participants' socio-demographic characteristics, which are theoretically and empirically associated to the maternal health behaviors investigated in this study (Burns et al, 2008;Demas et al, 2005;Mellins et al, 2003;Riley et al, 2011). Most of the participants in this study reported being single or not living with a marital partner, regardless of this partner being the father of the infant they were expecting.…”

“…It also suggests potential benefits in attending to the relationship a woman has with her unborn child perhaps as an additional component of her prenatal care to possibly help resolve her struggles with health behaviors. Does attending to this prenatal relationship promote her health behaviors by focusing on the woman-identified aspirations and possibilities, rather than the expert-identified barriers and problems (Saleebey, 2006) in general, to poor health practices among HIV-infected women (Demas et al, 2005;Mellins et al, 2003). Napravick et al (2000) using a deficit-based framework found that lack of support and unplanned pregnancy were among the most important barriers for HIV-infected women in accessing prenatal care.…”