Tonse Pamodzi: Developing a combination strategy to support adherence to antiretroviral therapy and HIV pre-exposure prophylaxis during pregnancy and breastfeeding

Abstract

To eliminate mother-to-child transmission of HIV (EMTCT), scalable strategies to enhance antiretroviral adherence for both antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are needed as part of integrated HIV and maternal-child health services. We developed Tonse Pamodzi (“all of us together”), an adaptable intervention integrating biomedical and behavioral components to support HIV treatment and prevention. We describe our intervention development process, which comprised formative qualitative research, a review of the literature, and technical input from stakeholders representing the community, health systems, and policymakers. The resulting intervention, described herein, integrates patient-centered counseling and engagement of a patient-selected adherence supporter for pregnant and breastfeeding women initiating ART or PrEP. Patients receiving the intervention engage in Integrated Next Step Counseling (iNSC) sessions delivered by trained counselors to build and maintain adherence skills. Each patient also has the option of selecting an adherence supporter (partner, family member, or friend) who may participate in iNSC sessions and provide adherence support outside of these sessions. This flexible intervention is adaptable not only to ART or PrEP use, but also to the needs and preferences of each woman and the clinical context. If shown to be acceptable and feasible, the Tonse Pamodzi intervention may be an important tool in continuing efforts for EMTCT.

Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention

“…42 There are several potential intervention implications from our study. First, interventions to address barriers to PrEP initiation (ie, providing patientcentered counseling on HIV risk perception, increasing knowledge of available HIV-prevention tools, using decision aids to facilitate communication, providing adherence support) may increase PrEP acceptability and initiation, [43][44][45][46] though to our knowledge, these interventions are in early stages of implementation and none have been evaluated for use with pregnant individuals in the United States. Second, health care professional or clinic-level interventions may also increase PrEP acceptability and subsequently affect demand.…”

Adverse Impact of Intimate Partner Violence Against HIV-Positive Women During Pregnancy and Post-Partum: Results From a Meta-Analysis of Observational Studies

“…Their results reported the 91% reduced odds of adherence to infant antiretroviral prophylaxis for HIV-positive IPV survived mothers compared to their IPV-free counterparts (Hampanda, 2016). Poor adherence to infant antiretroviral prophylaxis could lead to drug resistance, treatment failure, and HIV vertical transmission (Haas et al, 2016; Hill et al, 2021; Kirsten et al, 2011; Nachega et al, 2012). Our study identified that women who experienced IPV during pregnancy or post-partum had the higher odds of having poor adherence to HIV prophylaxis for their infants.…”

Understanding PrEP decision making among pregnant women in Lilongwe, Malawi: A mixed‐methods study

“…Data were collected from June 2020 to June 2021 in a pilot trial of an adherence support programme for women using antiretroviral drugs (ARVs) for either HIV treatment or prevention during pregnancy and breastfeeding. The intervention and pilot study are described elsewhere [ 24 , 25 ]. The sub‐study presented here was nested within the Tonse Pamodzi 2 (TP2) PrEP trial that enrolled pregnant women at risk of HIV acquisition interested in initiating daily oral PrEP ( n = 200).…”