Prenatal and Postpartum Zidovudine Adherence Among Pregnant Women with HIV

Ickovics, Jeannette R.; Wilson, Tracey E.; Royce, Rachel A.; Minkoff, Howard; Fernández, M. Isabel; Fox-Tierney, Rachel A.; Koenig, Linda J.

doi:10.1097/00126334-200207010-00007

Cited by 49 publications

(19 citation statements)

References 9 publications

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“…The other 51 studies [25–74] involving 20,153 HIV-infected pregnant women were included; 48 studies reporting 71 adherence estimates were included in the meta-analysis. The remaining three studies [56, 64, 75] reported ART adherence as mean or median adherence and could not be included in the meta-analysis. Kappa agreement was 0.96 between JBN and OUA for inclusion of studies in this meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies measured adherence using self-reported questionnaires (n=26, 51%), followed by pill counting (n=9, 18%), and pharmacy refills or claims-based (n=5, 10%). Five studies (9%) used blood drug concentrations (cord blood [43, 44, 50, 74] and red blood cells [36]) to measure ART adherence; one study used electronic medication-events-monitoring system (MEMS caps) [64]. Most of the studies reported adherence during antepartum period (n=39, 76%), four (8%) reported adherence during postpartum period, and eight (16%) reported both antepartum and postpartum adherence rates.…”

Section: Resultsmentioning

confidence: 99%

“…Adherence estimates of the three studies not included in the meta-analysis were as follows: Chung et al [56] reported ART adherence was 96% by pill count. Using MEMS caps, Ickovics[64] reported that the mean adherence to antepartum ZDV was extremely low (50·0%), with a statistically significant decline in mean postpartum adherence after three weeks (34·1%) (p=0·04). Leisegang et al [75] estimated median overall pharmacy claims-based ART adherence of women who were pregnant when starting ART at 54·0%.…”

Section: Resultsmentioning

confidence: 99%

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Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries

Nachega

Uthman

Anderson

et al. 2012

Aids

426

428

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Objective To estimate ART adherence rates during pregnancy and postpartum in high-, middle- and low-income countries. Design Systematic review and meta-analysis Methods MEDLINE, EMBASE, SCI Web of Science, NLM Gateway and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. Results Of 72 eligible articles, 51studies involving 20,153 HIV-infected pregnant women were included. Most studies were from United States (n=14, 27%) followed by Kenya (n=6, 12%), South Africa (n=5, 10%), and Zambia (n=5, 10%). The threshold defining good adherence to ART varied across studies (>80%, >90%, >95%, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% (95% confidence interval [CI] 69·3–77·5%, I2=97·7%) of pregnant women had adequate (>=80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75·7%, 95% CI 71·5–79·7%) than during postpartum (53·0%, 95% 32.8% to 72·7%) (p=0·005). Selected reported barriers for non-adherence included physical, economic and emotional stresses, depression (especially post-delivery), alcohol or drug use, and ART dosing frequency or pill burden. Conclusion Our findings indicate that only 73·5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them are urgently needed globally.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries

Nachega

Uthman

Anderson

et al. 2012

Aids

426

428

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“…Perhaps once the risk of HIV-1 transmission to an unborn child has passed, the tolerance for side effects may diminish. In one study using MEMS caps to track adherence, the overall adherence rate in the post partum period was 34% (23). Bardeguez et al found that adherence rates fell by 10% from prepartum to 48 weeks post partum (24).…”

Section: Discussionmentioning

confidence: 99%

Combination Antiretroviral Treatment for Women Previously Treated Only in Pregnancy

Vogler

Smeaton

Wright

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Women with HIV and prior exposure to combination antiretroviral therapy (cART) solely for prevention of Mother to Child Transmission (pMTCT) need to know whether they can later be treated successfully with a commonly used regimen of efavirenz (EFV) and co-formulated emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) Methods Non-pregnant women with plasma HIV-1 RNA of ≥ 500 copies/mL, previously cART- exposed for pMTCT only, were eligible if they were off ART for ≥ 24 weeks prior to entry, were without evidence of drug resistance on standard genotyping, and were ready to start EFV plus FTC/TDF. The primary endpoint was virologic response (defined as plasma HIV RNA <400 copies/mL) at 24 weeks. Results 54 women were enrolled between 10/07 and 12/09; 52/54 completed 24 weeks of follow- up. Median baseline CD4+ T-cell count was 265/mm3 and baseline plasma HIV-1 RNA was 4.6 log10 copies/mL. Median prior cART duration was 14 weeks, and median time elapsed from the last pMTCT dose to entry was 22 months. Virologic response at 24 weeks was observed in 42/52 women or 81% (exact 95% CI: 68%–90%). There were no differences in response by country, by number or class of prior pMTCT exposures. While confirmed virologic failure occurred in 8 women, no virologic failures were observed in women reporting perfect early adherence. Conclusions In this first prospective clinical trial studying combination antiretroviral re- treatment in women with a history of pregnancy-limited cART, the observed virologic response to TDF/FTC and EFV at 24 weeks was 81%. Virologic failures occurred and correlated with self-reported non-adherence.

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“…diabetes) may improve adherence during pregnancy but increase poor health behaviors postpartum (Zorilla et al, 2003). Although improved ART adherence during pregnancy versus postpartum has been shown in several studies, high rates of non-adherence have been shown in both groups (Ickovics et al, 2002;Tedaldi et al, 2002). Changes in healthcare providers following pregnancy and competing demands of childcare, work and other responsibilities may cause women to neglect their own health postpartum .…”

Section: Introductionmentioning

confidence: 99%

Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women

et al. 2008

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Among women with HIV infection, pregnancy is a time when maintenance of maternal health and reduction of vertical HIV transmission are primary concerns. Few studies have examined adherence to Antiretroviral Treatment (ART) during pregnancy and in the postpartum period when the demands of childcare may significantly interfere with women's self-care behaviors. This study examined ART use and adherence in HIV-infected pregnant and postpartum women participating in the Women and Infants Transmission Study (WITS-IV) in the US. Adherence was assessed through a self-report interview during the third trimester of pregnancy and six-month postpartum. Data were also collected on demographics, biomedical markers and health related symptoms. During the third trimester visit, 77% (309/399) of women completed the self-report adherence measure; 61% (188/309) reported complete adherence. Factors associated with non-adherence included advanced HIV disease status, higher HIV-RNA viral load, more health-related symptoms and alcohol and tobacco use. At six-month postpartum, 55% (220/399) completed the measure; 44% (97/220) of these women reported complete adherence. Factors associated with non-adherence during the postpartum period were ethnicity, more health-related symptoms and WITS clinical site. Results of multivariate analyses using Generalized Estimated Equation analyses across the two visits revealed that more health-related symptoms, higher HIV-RNA viral load, increased alcohol use and clinical site were independently associated with ART non-adherence. These analyses indicate that medication adherence is more likely during pregnancy than postpartum in HIV-infected women, perhaps provoked by motivation to reduce vertical transmission and/or intensive antepartum surveillance. Further investigation is warranted to clarify factors implicated in women's decision-making process regarding ART medication adherence.

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Prenatal and Postpartum Zidovudine Adherence Among Pregnant Women with HIV

Cited by 49 publications

References 9 publications

Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries

Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries

Combination Antiretroviral Treatment for Women Previously Treated Only in Pregnancy

Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women

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