Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: A systematic review and meta-analysis

Jean B. Nachega, Olalekan A. Uthman, Jean Anderson, Karl Peltzer, Sarah Wampold, Mark F. Cotton, Edward J. Mills, Yuh Shan Ho, Jeffrey S A Stringer, James A. McIntyre, Lynne M. Mofenson

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-income, middle-income, and low-income countries. DESIGN: Systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. RESULTS: Of 72 eligible articles, 51 studies involving 20153 HIV-infected pregnant women were included. Most studies were from United States (n=14, 27%) followed by Kenya (n=6, 12%), South Africa (n=5, 10%), and Zambia (n=5, 10%). The threshold defining good adherence to ART varied across studies (>80, >90, >95, 100%). A pooled analysis of all studies indicated a pooled estimate of 73.5% [95% confidence interval (CI) 69.3-77.5%] of pregnant women who had adequate (>80%) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75.7%, 95% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 32.8-72.7%; P=0.005). Selected reported barriers for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery), alcohol or drug use, and ART dosing frequency or pill burden. CONCLUSION: Our findings indicate that only 73.5% of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them is urgently needed globally.

Original languageEnglish (US)
Pages (from-to)2039-2052
Number of pages14
JournalAIDS
Volume26
Issue number16
DOIs
StatePublished - Oct 23 2012

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Meta-Analysis
Pregnancy
Pregnant Women
Postpartum Period
Confidence Intervals
Therapeutics
HIV
Zambia
Publication Bias
Kenya
Pregnancy Rate
South Africa
Psychological Stress
MEDLINE
Alcohols
Economics
Databases
Depression
Research
Pharmaceutical Preparations

Keywords

  • adherence
  • antiretroviral therapy
  • HIV infection
  • pregnancy
  • prevention of mother-to-child HIV transmission

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries : A systematic review and meta-analysis. / Nachega, Jean B.; Uthman, Olalekan A.; Anderson, Jean; Peltzer, Karl; Wampold, Sarah; Cotton, Mark F.; Mills, Edward J.; Ho, Yuh Shan; Stringer, Jeffrey S A; McIntyre, James A.; Mofenson, Lynne M.

In: AIDS, Vol. 26, No. 16, 23.10.2012, p. 2039-2052.

Research output: Contribution to journalArticle

Nachega, JB, Uthman, OA, Anderson, J, Peltzer, K, Wampold, S, Cotton, MF, Mills, EJ, Ho, YS, Stringer, JSA, McIntyre, JA & Mofenson, LM 2012, 'Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: A systematic review and meta-analysis', AIDS, vol. 26, no. 16, pp. 2039-2052. https://doi.org/10.1097/QAD.0b013e328359590f
Nachega, Jean B. ; Uthman, Olalekan A. ; Anderson, Jean ; Peltzer, Karl ; Wampold, Sarah ; Cotton, Mark F. ; Mills, Edward J. ; Ho, Yuh Shan ; Stringer, Jeffrey S A ; McIntyre, James A. ; Mofenson, Lynne M. / Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries : A systematic review and meta-analysis. In: AIDS. 2012 ; Vol. 26, No. 16. pp. 2039-2052.
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abstract = "OBJECTIVE: To estimate antiretroviral therapy (ART) adherence rates during pregnancy and postpartum in high-income, middle-income, and low-income countries. DESIGN: Systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, SCI Web of Science, NLM Gateway, and Google scholar databases were searched. We included all studies reporting adherence rates as a primary or secondary outcome among HIV-infected pregnant women. Two independent reviewers extracted data on adherence and study characteristics. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity, and publication bias were assessed. RESULTS: Of 72 eligible articles, 51 studies involving 20153 HIV-infected pregnant women were included. Most studies were from United States (n=14, 27{\%}) followed by Kenya (n=6, 12{\%}), South Africa (n=5, 10{\%}), and Zambia (n=5, 10{\%}). The threshold defining good adherence to ART varied across studies (>80, >90, >95, 100{\%}). A pooled analysis of all studies indicated a pooled estimate of 73.5{\%} [95{\%} confidence interval (CI) 69.3-77.5{\%}] of pregnant women who had adequate (>80{\%}) ART adherence. The pooled proportion of women with adequate adherence levels was higher during the antepartum (75.7{\%}, 95{\%} CI 71.5-79.7{\%}) than during postpartum (53.0{\%}, 95{\%} CI 32.8-72.7{\%}; P=0.005). Selected reported barriers for nonadherence included physical, economic and emotional stresses, depression (especially postdelivery), alcohol or drug use, and ART dosing frequency or pill burden. CONCLUSION: Our findings indicate that only 73.5{\%} of pregnant women achieved optimal ART adherence. Reaching adequate ART adherence levels was a challenge in pregnancy, but especially during the postpartum period. Further research to investigate specific barriers and interventions to address them is urgently needed globally.",
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AU - Peltzer, Karl

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AU - Cotton, Mark F.

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