Last data updates: 06 January 2016
Nachega, J.B., Uthman, O.A., Anderson, J., Peltzer, K., Wampold, S., Cotton, M.F., Mills, E.J., Ho,
Y.S., Stringer, J.S.A., McIntyre, J.A. and Mofenson, L.M. (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, 26 (16), 2039-2052.
Document type: Article;
Proceedings Paper
Language:
English
Cited references: Times cited: Times self
101
75
cited: 3
Abstract: Objective: To estimate anti retroviral 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 (Cl) 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% Cl 71.5-79.7%) than during postpartum
(53.0%, 95% Cl 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. (C) 2012 Wolters Kluwer Health vertical bar Lippincott
Williams & Wilkins
Author Keywords: Adherence; Antiretroviral Therapy; HIV Infection; Prevention of Mother-to-Child
HIV Transmission; Pregnancy
KeyWords Plus: Child Hiv Transmission; Single-Dose Nevirapine; Randomized Controlled-Trial;
Human-Immunodeficiency-Virus; Short-Course Zidovudine; Womens Interagency Hiv; Infected
Women; South-Africa; Prospective Cohort; Greater Adherence
Reprint Address: Nachega, JB (reprint author), Johns Hopkins Univ, Dept Int Hlth, Bloomberg Sch
Publ Hlth, Global Dis Epidemiol & Control Program, 615N Wolfe St,Suite W5031, Baltimore,
MD 21205 USA.
Addresses:
1. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA
2. Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
3. Univ Stellenbosch, Fac Hlth Sci, Dept Med, Cape Town, South Africa
4. Univ Stellenbosch, Fac Hlth Sci, Ctr Infect Dis, Cape Town, South Africa
5. Univ Stellenbosch, Fac Hlth Sci, Ctr Evidence Based Healthcare, Cape Town, South Africa
6. Keele Univ, Dept Primary Care Sci, Keele, Staffs, England
7. Johns Hopkins Univ Hosp, Dept Gynecol & Obstet, Baltimore, MD 21287 USA
8. Human Sci Res Council, Pretoria, South Africa
9. Univ Orange Free State, Bloemfontein, South Africa
10. Univ Stellenbosch, Fac Hlth Sci, Tygerbergs Children Hosp, Dept Pediat & Child Hlth, Cape
Town, South Africa
11. Univ Ottawa, Fac Hlth Sci, Ottawa, ON, Canada
12. Asia Univ, Trend Res Ctr, Taichung, Taiwan
13. Ctr Infect Dis Res, Lusaka, Zambia
14. Univ Alabama Birmingham, Birmingham, AL USA
15. Anova Hlth Inst, Johannesburg, South Africa
16. Univ Cape Town, Sch Publ Hlth & Family Med, ZA-7925 Cape Town, South Africa
17. Eunice Kennedy Shriver Natl Inst Child Hlth & Hum, Pediat Adolescent & Maternal AIDS
Branch, NIH, Bethesda, MD USA
E-mail Address: jnachega@jhsph.edu
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