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A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy

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Abstract

Maternal adherence to antiretroviral therapy (ART) is a concern and monitoring adherence presents a significant challenge in low-resource settings. We investigated the association between self-reported adherence, measured using a simple three-item scale, and elevated viral load (VL) among HIV-infected pregnant and postpartum women on ART in Cape Town, South Africa. This is the first reported use of this scale in a non-English speaking setting and it achieved good psychometric characteristics (Cronbach α = 0.79). Among 452 women included in the analysis, only 12 % reported perfect adherence on the self-report scale, while 92 % had a VL <1000 copies/mL. Having a raised VL was consistently associated with lower median adherence scores and the area under the curve for the scale was 0.599, 0.656 and 0.642 using a VL cut-off of ≥50, ≥1000 and ≥10000 copies/mL, respectively. This simple self-report adherence scale shows potential as a first-stage adherence screener in this setting. Maternal adherence monitoring in low resource settings requires attention in the era of universal ART, and the value of this simple adherence scale in routine ART care settings warrants further investigation.

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Acknowledgments

The authors would like to thank the women who participated in this study, as well as the study staff for their support of this research. This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), Grant Number 1R01HD074558. Drs. Mellins and Remien were also supported by the HIV Center for Clinical and Behavioral Studies (P30-MH43520). Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation.

Funding

This study was funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), Grant Number 1R01HD074558. Drs. Mellins and Remien were also supported by the HIV Center for Clinical and Behavioral Studies (P30-MH43520). Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation.

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Authors and Affiliations

  1. Division of Epidemiology & Biostatistics, Faculty of Health Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa

    Tamsin Phillips, Kirsty Brittain & Landon Myer

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA

    Claude A. Mellins & Robert H. Remien

  3. ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA

    Allison Zerbe & Elaine J. Abrams

  4. College of Physicians & Surgeons, Columbia University, New York, NY, USA

    Elaine J. Abrams

  5. Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    Ira B. Wilson

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  1. Tamsin Phillips
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  2. Kirsty Brittain
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  3. Claude A. Mellins
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  4. Allison Zerbe
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  6. Elaine J. Abrams
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Correspondence to Tamsin Phillips.

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All authors declare that they have no conflict of interest.

Ethical Approval

This study was conducted in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments, and was approved and conducted in accordance with the standards of the Human Research Ethics Committee of the University of Cape Town as well as the Institutional Review Board of the Columbia University Medical Centre. Written informed consent was obtained from all individual participants included in the study.

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Phillips, T., Brittain, K., Mellins, C.A. et al. A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy. AIDS Behav 21, 450–461 (2017). https://doi.org/10.1007/s10461-016-1448-0

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