Adherence support

Published: 01 June 2012

Women may require additional support with remaining adherent to their HIV treatment during pregnancy, and especially in the period after giving birth. Adherence levels have been found to be far from optimal in pregnant women, and to become worse in the months after the birth – and the women's viral loads have been found to reflect the level of their adherence, with those with perfect adherence having lower viral loads.1

Studies have shown that women with advanced HIV disease, higher viral load, more health-related symptoms, and alcohol and tobacco use were less likely to be adherent.2 In one UK study, findings suggest that age, ethnicity and pre-pregnancy HIV diagnosis do not affect adherence, but being treatment-naive and having poor adherence may predict non-attendance for follow-up care for their baby.3 

As in the other studies, research on women enrolled in a drug treatment programme suggests that adherence levels during these times are low overall, although significantly better during pregnancy than after the birth.4 

Antenatal care should include advice and help with adherence. The BHIVA/CHIVA guidelines recognise that: "pregnant women may need extra support and planning in this area, especially if there are practical or psychosocial issues that may impact adversely on adherence. Referral to peer support workers, psychology support and telephone contact may all be considered".5

In cases where women are on complex therapies, or have co-infections, therapeutic drug monitoring is also recommended.6

References

  1. Bardeguez AD et al. Adherence to antiretrovirals among US women during and after pregnancy. J Acquir Immune Defic Syndrome 48: 408-417, 2008
  2. Mellins CA et al. Adherence to antiretroviral treatment among pregnant and postpartum HIV-infected women. AIDS Care 20(8), 968-968, 2008
  3. Kingston MA, Letham CJ, McQuillan O Adherence to antiretroviral therapy in pregnancy. International Journal of STD & AIDS, Volume 18, Number 11, 2007
  4. Kaida A et al. Antiretroviral adherence during pregnancy and postpartum among HIV-positive women enrolled in the Drug Treatment Program in British Columbia, Canada. Eighteenth Annual Canadian Conference on HIV/AIDS Research, Vancouver, abstract 0046, 2009
  5. de Ruiter A et al. British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008. HIV Med 9: 452-502. Available online at www.bhiva.org, 2008
  6. NHS Audit, Information and Analysis Unit, NSHPC and CHIVA Perinatal Transmission of HIV in England 2002-2005 October, 2007
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.