Maternal Adherence to the Zidovudine Regimen for HIV-Exposed Infants to Prevent HIV Infection: A Preliminary Study

Abstract

ABSTRACT. Objective. To describe the extent of adherence to the recommended neonatal zidovudine (ZDV) regimen administered to infants who have been exposed to the human immunodeficiency virus (HIV) to prevent mother-to-child transmission of HIV and to determine which maternal factors are associated with compliance.Methods. HIV-infected women (n ‫؍‬ 87) who were participating in a larger study of perinatal transmission at 3 inner-city New York City hospitals were interviewed 2 to 6 weeks' postpartum to assess adherence to neonatal prophylaxis, social support, social network factors, and depression. In addition, plasma samples of 45 of their infants were assayed for ZDV levels.Results. A majority of women (71%) administered all of the prescribed 4 daily doses in the previous week, as measured by interview; self-reported adherence was not associated with any maternal characteristics. In contrast, poor adherence, as measured by lower infant ZDV plasma levels, was associated with asymptomatic HIV illness in the mother and having 2 or more other children; good adherence, as indicated by higher ZDV levels, was associated with the presence of a maternal social support network, disclosure of HIV infection, and mothers' adherence to their own ZDV regimens during pregnancy. In multivariate regression analyses, maternal asymptomatic status (␤ ‫؍‬ ؊0.40) was associated with lower infant ZDV levels, and maternal adherence during pregnancy (␤ ‫؍‬ 0.37) was associated with higher levels.Conclusions. Women who are HIV asymptomatic and lack a social support network are more likely not to comply with the recommended neonatal prophylactic regimen of antiretroviral therapy. Future studies should address the prenatal period and social network factors, such as disclosure of serostatus, and the custody of other children. Pediatrics 2002;110(3). URL: http://www. pediatrics.org/cgi/content/full/110/3/e35; adherence, mother-to-child transmission, zidovudine, perinatal HIV infection. Prophylactic treatment of all infected pregnant women and their infants with the 076 regimen was subsequently recommended by the US Public Health Service 2 and rapidly became the standard of care. A later study indicated reduced transmission rates in infants who were treated with ZDV within 48 hours of birth, even in the absence of maternal treatment. 3 The current prophylaxis for full-term HIV-exposed infants includes a 6-week course of oral ZDV 4 times daily in doses of 2 mg/kg body weight, initiated as soon as possible, and within 12 to 24 hours of delivery. 2 Understanding factors that are associated with adherence to neonatal prophylaxis has become increasingly important as greater proportions of HIV-exposed infants are being identified and treated as a result of more aggressive prenatal HIV testing policies 4 and recent advances in rapid HIV testing technology that could expedite the initiation of treatment for exposed neonates. 5 In August 1999, New York became the first state to legislate universal testing of women with undocumented HIV status or their...

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-Time Identification and Remediable Risks

“…5,6 One recent study of frequently hospitalized urban residents found diagnoses of substance use and mental illness to be strong predictors of fragmented care and admissions to multiple, unrelated facilities. 7 The majority of studies examining risk factors associated with frequent hospital admissions focus only on patients with specific diagnoses such as HIV, congestive heart failure or psychiatric disease, or in specific age ranges such as infants or the elderly.…”

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

“…Satisfaction with support was found to mediate the relationship between adaptive coping and psychological distress in a sample of Hispanic and African-American women (Simoni, Demas, Mason, Drossman, & Davis, 2000). Disclosure has been related to the availability (Moneyham et al, 1996) and frequency (Simoni et al, 2000) of social support in samples of seropositive women and to adherence among samples of infected mothers for their own treatment (Mellins et al, 2002) and for postnatal prophylaxis of the exposed infant (Demas et al, 2002).…”

Suporte social de gestantes com HIV: revisão narrativa

“…Participação em programas de prevenção 13,16,[18][19][20][23][24][25][26][27][28] Acolhimento da equipe de saúde 11,16,21,24 Educação em saúde 20 Conforto das condições de saúde 24 Divulgação do estado sorológico [16][17][18][19] Aderir às medidas de profilaxia da TV 11,[16][17][18][19] Repercussões na saúde sexual 13 Deus e a fé 15,24,27 Divulgação do estado sorológico 29 Motivação para aceitar o diagnóstico e o tratamento 24 repercussões na saúde sexual: consideraram-se com maior capacidade para negociar o planejamento familiar, além do uso de preservativo, e solicitar ao companheiro que realizasse o teste de anticorpos do HIV.…”

“…Quanto à categoria suporte social emocional, observaram-se como fontes a família, 12,14,15,24,25,[27][28][29] o companheiro, 10,22,26 os amigos 15,24,27 e a crença em Deus e a fé, 15,24,27 como estímulos para continuidade do tratamento. Fica explícito que as questões culturais e familiares influenciaram nas decisões em relação aos cuidados de saúde maternos e infantis.…”

“…29 Mesmo com medo devido à estigmatização e preconceito, as mulheres com HIV revelaram seu status sorológico, principalmente ao companheiro (78%), e apenas 39,6% divulgaram a sorologia a familiares, amigos e pastores. Com isso, elas receberam maior apoio nos cuidados com o RN e na manutenção da alimentação infantil, principalmente por familiares do sexo feminino.…”