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Factors associated with non-adherence to HAART in HIV-positive pregnant women during pregnancy, peri- and postpartum in Lima, Peru
Retrovirologyvolume 7, Article number: P46 (2010)
To determine factors associated with non-adherence to HAART in HIV-positive pregnant women.
We used adherence data collected by the LILAC study in Peru based on the AACTG questionnaire, in HIV-positive women during pregnancy, peripartum and 2 months postpartum.
We studied 44 women. The mean age was 27,9+5,9 years. At enrollment 86,4% were on HAART, although at delivery 100% had received HAART; of whom 27,3% for PMTCT. Majority (61,4%) were in their first HAART regimen, and the most commonly used was 2NRTI+2PI (56,8%) followed by 2NRTI+1NNRTI (34,1%), with a median of 2 tablets per day, and for an average of 31,1+41,5 months. During pregnancy, non-adherence was 7,3%, and increased in the peri- and postpartum (21,2% and 15%, respectively). More women (34,1%) reported missing a dose during pregnancy, 27,3% in peripartum and 21,9% at 2 months postpartum. Among the most common reasons cited for missing doses were "being away from home" (76,7%) and "a change in routine" (70%). Among those who had not missed a dose, women reported having trouble taking the medications during pregnancy (11,1%), at birth (3%) and 2 months postpartum (13,3%). The factors associated with non-adherence in the peri- and postpartum were taking more than 2 pills a day (p = 0,027) and a longer duration of HIV infection (p = 0.002) respectively. Factors associated with ever having missed a dose in the peripartum were taking more than 2 pills a day (p = 0.005) and taking a regimen that included PI (p = 0.021); and in the postpartum working outside the house (p = 0,047).
Adherence to HAART decreases markedly in the peripartum, by the change in routine that involves the cesarean section, and in the postpartum possible because women have to work outside the house. Further studies that consider others factors such as psychological are needed. The small sample size was a limitation of the present study.