Bardequez, A. D., Lindsey, J. C., Shannon, M., Tumala, R. E., Cohn, S. E., Smith, E., et al. (2008). Journal of Acquired Immune Deficiency Syndrome, 48, 408-417.

The use of highly active antiretroviral therapy (HAART) has dramatically decreased the morbidity and mortality of HIV-1-infected patients. Current recommendations indicate that HIV-1-infected women receive antiretrovirals (ARVs) during pregnancy to prevent mother-to-child transmission (MTCT) and for their own health. Data also indicate that poor adherence to ARV therapy during pregnancy can lead to suboptimal viral suppression, development of viral resistance, higher risk of MTCT, and MTCT of a resistant HIV-1 strain. The purpose of this study was to describe the antepartum and postpartum adherence to ARV regimens and factors associated with adherence. Adherence rates among participants enrolled in the Pediatric AIDS Clinical Trials Group Protocol from August 2002 to July 2005 were based on self-report and assessed at each study visit. Data regarding current ARV regimen, number of doses missed for each ARV of the regimen over the 4 days before the visit, and the last time an ARV was missed were assessed. Factors thought to influence adherence were also assessed, including support network, health status, attitudes regarding taking ARVs, reasons for missed doses, and use of any aids to improve adherence. Adherence was classified as perfect if the patient attended the clinic visit, completed the self-report adherence form, and provided information on all drugs over the 4 days before the study visit. Conversely, adherence was classified as imperfect if at least one dose of any ARV was missed or if there was incomplete information on any of the 4 days. Generalized estimating equations were used to compare antepartum with postpartum adherence rates and to identify factors associated with perfect adherence. Results indicated that of 519 eligible subjects, 75% reported perfect adherence during pregnancy. This rate significantly (p < .01) decreased 6, 24, and 48 weeks postpartum (65%, 64%, and 66%, respectively). Pregnant patients with perfect adherence had lower viral loads. The odds of perfect adherence were significantly higher for women who initiated ARVs during pregnancy (p < .01), did not have AIDS (p = .02), never missed prenatal vitamins (p < .01), never used marijuana (p = .05), or felt happy most of the time (p < .01). Clearly, these results indicated the need for interventions to improve adherence during the prenatal period and throughout pregnancy. Maternal-child health nurses are well prepared and positioned to incorporate evidence-based adherence strategies to enhance interventions in prenatal, pregnancy, postpartum, and well-child visits.

Laura L. Hayman