PMID- 32820622
OWN - NLM
STAT- MEDLINE
DCOM- 20210513
LR  - 20231112
IS  - 1758-2652 (Electronic)
IS  - 1758-2652 (Linking)
VI  - 23
IP  - 8
DP  - 2020 Aug
TI  - 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.
PG  - e25586
LID - 10.1002/jia2.25586 [doi]
LID - e25586
AB  - INTRODUCTION: We 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. METHODS: We 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. RESULTS: In 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. CONCLUSIONS: Women 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.
CI  - (c) 2020 The Authors. Journal of the International AIDS Society published by John 
      Wiley & Sons Ltd on behalf of the International AIDS Society.
FAU - Matthews, Lynn T
AU  - Matthews LT
AUID- ORCID: 0000-0001-6167-6328
AD  - Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
AD  - Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
FAU - Orrell, Catherine
AU  - Orrell C
AD  - Desmond Tutu Foundation, Rondebosch, South Africa.
FAU - Bwana, Mwebesa Bosco
AU  - Bwana MB
AD  - Mbarara University of Science and Technology, Mbarara, Uganda.
FAU - Tsai, Alexander C
AU  - Tsai AC
AD  - Mbarara University of Science and Technology, Mbarara, Uganda.
AD  - Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
AD  - Harvard Center for Population and Development Studies, Boston, MA, USA.
FAU - Psaros, Christina
AU  - Psaros C
AUID- ORCID: 0000-0002-0705-2239
AD  - Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
FAU - Asiimwe, Stephen
AU  - Asiimwe S
AD  - Mbarara University of Science and Technology, Mbarara, Uganda.
AD  - Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
AD  - Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda.
FAU - Amanyire, Gideon
AU  - Amanyire G
AD  - Makerere-Mbarara Universities Joint AIDS Program (MJAP), Mbarara, Uganda.
FAU - Musinguzi, Nicholas
AU  - Musinguzi N
AD  - Mbarara University of Science and Technology, Mbarara, Uganda.
AD  - Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
FAU - Bell, Kathleen
AU  - Bell K
AD  - Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
FAU - Bangsberg, David R
AU  - Bangsberg DR
AD  - School of Public Health, Oregon Health and Science University/Portland State 
      University, Portland, OR, USA.
FAU - Haberer, Jessica E
AU  - Haberer JE
AD  - Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
AD  - Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
CN  - META Study Investigators
LA  - eng
GR  - OPP113634/GATES/Bill & Melinda Gates Foundation/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Switzerland
TA  - J Int AIDS Soc
JT  - Journal of the International AIDS Society
JID - 101478566
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/*therapeutic use
MH  - CD4 Lymphocyte Count
MH  - Cohort Studies
MH  - Female
MH  - HIV Infections/*drug therapy
MH  - Health Surveys
MH  - Humans
MH  - *Medication Adherence
MH  - Postpartum Period
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/*drug therapy
MH  - Rural Population
MH  - South Africa
MH  - Uganda
MH  - Urban Population
PMC - PMC7441010
OTO - NOTNLM
OT  - ARV
OT  - Africa < Region
OT  - Cohort studies
OT  - HIV
OT  - adherence
OT  - cohort studies
OT  - gender
OT  - women
FIR - April, Nomakhaya
IR  - April N
FIR - Mpahleni, Alienah
IR  - Mpahleni A
FIR - Situlo, Vivie
IR  - Situlo V
FIR - Mzamo, Speech
IR  - Mzamo S
FIR - Ngwenya, Nomsa
IR  - Ngwenya N
FIR - Panda, Khosi Tshangela Regina
IR  - Panda KTR
FIR - Linda, Teboho
IR  - Linda T
FIR - Atwiine, Christine
IR  - Atwiine C
FIR - Moonight, Sheila
IR  - Moonight S
FIR - Tindimwebwa, Edna
IR  - Tindimwebwa E
FIR - Mugisha, Nicholas
IR  - Mugisha N
FIR - Atwogeire, Peace
IR  - Atwogeire P
FIR - Namana, Vian
IR  - Namana V
FIR - Kyampaire, Catherine
IR  - Kyampaire C
FIR - Nuwagaba, Gabriel
IR  - Nuwagaba G
FIR - Kembabazi, Annet
IR  - Kembabazi A
FIR - Mugisha, Stephen
IR  - Mugisha S
FIR - Nanfuka, Victoria
IR  - Nanfuka V
FIR - Cross, Anna
IR  - Cross A
FIR - Kelly, Nicky
IR  - Kelly N
FIR - Moralie, Daphne
IR  - Moralie D
FIR - Cogill, Dolphina
IR  - Cogill D
FIR - Ashaba, Justus
IR  - Ashaba J
FIR - Xapa, Zoleka
IR  - Xapa Z
FIR - Orimwesiga, Mathias
IR  - Orimwesiga M
FIR - Tuhanamagyezi, Elly
IR  - Tuhanamagyezi E
FIR - Mpanga, Don Bosco
IR  - Mpanga DB
FIR - Kyarisima, Leonia
IR  - Kyarisima L
FIR - Kigozi, Simone
IR  - Kigozi S
FIR - October, Edgar
IR  - October E
FIR - Mugisha, Silver
IR  - Mugisha S
FIR - Kiviiri, Ibrahim
IR  - Kiviiri I
FIR - Ware, Norma
IR  - Ware N
FIR - Elioda, Tumwesigye
IR  - Elioda T
FIR - Siedner, Mark J
IR  - Siedner MJ
FIR - Katz, Ingrid T
IR  - Katz IT
FIR - Wyatt, Monique
IR  - Wyatt M
EDAT- 2020/08/21 06:00
MHDA- 2021/05/14 06:00
PMCR- 2020/08/20
CRDT- 2020/08/22 06:00
PHST- 2019/12/19 00:00 [received]
PHST- 2020/06/18 00:00 [revised]
PHST- 2020/07/01 00:00 [accepted]
PHST- 2020/08/22 06:00 [entrez]
PHST- 2020/08/21 06:00 [pubmed]
PHST- 2021/05/14 06:00 [medline]
PHST- 2020/08/20 00:00 [pmc-release]
AID - JIA225586 [pii]
AID - 10.1002/jia2.25586 [doi]
PST - ppublish
SO  - J Int AIDS Soc. 2020 Aug;23(8):e25586. doi: 10.1002/jia2.25586.