Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12-month cohort study in urban South Africa and rural Uganda
Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12-month cohort study in urban South Africa and rural Uganda
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DOI：
10.1002/jia2.25586
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发表时间：
2020-08-01
影响因子：
6
通讯作者：
Haberer, Jessica E.
中科院分区：
文献类型：
--
作者：
Matthews, Lynn T.;Orrell, Catherine;Haberer, Jessica E.
我们进行了一项队列研究，以了解在乌干达农村和南非城市提供选项B+的公共诊所开始抗逆转录病毒治疗（ART）的妇女在怀孕期间，产后和非妊娠随访期间坚持ART的模式。（Wisepill），2015年至2017年，乌干达和南非开始抗逆转录病毒治疗的妇女在零，六和十二个月时的艾滋病毒RNA和妊娠试验。关注的主要预测因素是随访时间，分类为妊娠（妊娠诊断至妊娠结束）、产后（妊娠结束至研究退出）或非妊娠相关（既未妊娠也未产后）。分数回归模型包括人口统计学和社会行为因素，由弱势群体行为模型提供信息。我们评估了HIV-RNA在12个月的曾经与从未怀孕的status.ResultsIn乌干达，247名妇女贡献了676，900和1274个月的怀孕，产后和非妊娠相关的后续行动。中位ART依从性始终>= 90%：妊娠，94%（四分位距[IQR] 78，98）;产后，90%（IQR 70，97）和非妊娠，90%（IQR 80，98）。血小板粘附与年龄较小（每岁平均增加0.98% [95%CI 0.33%，1.62%]）和CD 4细胞计数较高（每50个细胞/mm 3平均减少1.01% [0.08%，1.94%]）相关。在91%（N = 135）的曾怀孕妇女和86%（N = 85）的从未怀孕妇女中，HIV-RNA被抑制。在南非，190名妇女提供了259、624和1247个月的妊娠、产后和非妊娠相关随访。妊娠期间的中位依从性较低，为74%（IQR 31，96）;产后为40%（IQR 4，65），非妊娠为77%（IQR 47，92）。产后依从性与产后状态（与非妊娠相关随访相比平均下降22.3% [95%CI 8.6%，35.4%]）和较少的情感支持（每单位增加平均增加1.4% [0.22%，2.58%]）相关。HIV-RNA被抑制之间57%（N = 47）曾经怀孕和86%（N = 93）never-pregnant women.ConclusionsWomen在农村乌干达保持高的依从性与91%的曾经怀孕和86%的never-pregnant妇女抑制HIV-RNA在12个月。南非城市妇女的依从性很差，特别是在产后随访期间，一年内HIV-RNA抑制妇女的依从性中位数为40%和57%，这表明南非产后艾滋病毒感染妇女面临危机。研究结果表明，有效的干预措施应促进情感支持。
IntroductionWe conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa.MethodsWe collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression models included demographics and socio-behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV-RNA at 12 months by ever- versus never-pregnant status.ResultsIn Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median ART adherence was consistently >= 90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non-pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/mm(3)). HIV-RNA was suppressed among 91% (N = 135) ever-pregnant and 86% (N = 85) never-pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non-pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non-pregnancy-related follow-up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIV-RNA was suppressed among 57% (N = 47) ever-pregnant and 86% (N = 93) never-pregnant women.ConclusionsWomen in rural Uganda maintained high adherence with 91% of ever-pregnant and 86% of never-pregnant women suppressing HIV-RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow-up with median adherence of 40% and 57% of women with HIV-RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.