Adherence to antiretroviral treatment by pregnant women living with HIV: Comparison of three methods
DOI:
https://doi.org/10.21527/2176-7114.2026.51.16250Keywords:
Pregnant women, HIV, Antiretroviral therapy, Treatment adherence, Pregnant. Newborn. Vertical transmission of infectious disease. HIV serodiagnosis.Abstract
Objective: To evaluate the prevalence of adherence to antiretroviral therapy among pregnant women using three assessment methods, compare adherence across these methods, and identify risk factors for non-adherence. Method: A cross-sectional study was conducted with pregnant women receiving care at a high-risk prenatal clinic of a tertiary hospital in southern Brazil. Participants completed an interview that included sociodemographic and clinical data collection, as well as the administration of an instrument for assessing adherence to antiretroviral therapy. Laboratory HIV viral load data and pharmacy dispensing records were also used to measure adherence. The study was approved by the Research Ethics Committee.
Results: Forty-one pregnant women participated. Adherence rates varied depending on the assessment method: viral load suppression (78.0%), frequency of medication withdrawal from the pharmacy (31.7%), and the validated adherence scale (29.3%). The three methods showed no agreement. Older pregnant women, those with more children, higher levels of education, and more prenatal visits were more likely to adhere to treatment. Conclusion: Adherence to antiretroviral therapy among pregnant women living with HIV was insufficient, increasing the risk of vertical transmission. The different assessment methods yielded divergent results. Factors such as age, number of children, education level, and prenatal attendance influenced adherence. The findings highlight the importance of combining different assessment methods to obtain a more comprehensive understanding of patients’ treatment-related needs.
References
1. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis (DCCI). Boletim Epidemiológico HIV/Aids 2023. Brasília (DF): Ministério da Saúde; 2023. Nº especial – dez/2023.
2. Cardenas MC, Farnan S, Hamel BL, Mejia Plazas MC, Sintim-Aboagye E, Littlefield DR, et al. Prevention of the vertical transmission of HIV; a recap of the journey so far. Viruses. 2023;15(4):849. doi:10.3390/v15040849.
3. Fedlu A, Alie B, Mohammed AS, Adem F, Hassen A. Adherence to antiretroviral treatment for prevention of mother-to-child transmission of HIV in Eastern Ethiopia: a cross-sectional study. HIV AIDS (Auckl). 2020;12:725-733. doi:10.2147/HIV.S274012.
4. Brasil. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Secretaria de Vigilância em Saúde. Protocolo clínico e diretrizes terapêuticas para prevenção da transmissão vertical do HIV, sífilis e hepatites virais. Brasília (DF): Ministério da Saúde; 2022.
5. Sellani MG, Trigueiro TH, Barbosa R. Experiência de puérperas que convivem com HIV/AIDS atendidas em maternidade de alto risco. Cienc Cuid Saude [Internet]. 2021 [cited 2024 Dec 8];20:e46606. Available from: http://www.periodicos.uem.br/ojs/index.php/CiencCuidSaude. doi:10.4025/cienccuidsaude.v20i0.46606.
6. World Health Organization. Adherence to long-term therapies: evidence for action. 1st ed. Geneva: WHO; 2003. Available from: https://iris.who.int/bitstream/handle/10665/42682/9241545992.pdf [Accessed: 2024 Apr 13].
7. Brasil. Ministério da Saúde. Manual do cuidado contínuo das pessoas vivendo com HIV/Aids. 1ª ed. atual. Brasília (DF): Ministério da Saúde; 2023.
8. Castro MS, Simoni CR. Adesão a medicamentos. In: Fuchs FD, Wannmacher L, editors. Farmacologia clínica e terapêutica. 5ª ed. Rio de Janeiro: Guanabara Koogan; 2017. p. 114-131.
9. Fernández-Luis S, Lain MG, Serna-Pascual M, Domínguez-Rodríguez S, Kuhn L, Liberty A, et al. Optimizing the World Health Organization algorithm for HIV vertical transmission risk assessment by adding maternal self-reported antiretroviral therapy adherence. BMC Public Health. 2022;22(1):1312. doi:10.1186/s12889-022-13543-9.
10. Ayele AD, Kassa BG, Mihretie GN, Belay HG, Sewyew DA, Semahegn AM, et al. Level of adherence to option B+ program and associated factors among HIV-positive women in Ethiopia: a systematic review and meta-analysis. PLoS One. 2024;19(4):e0298119. doi:10.1371/journal.pone.0298119.
11. Remor E. Valoración de la adhesión al tratamiento antirretroviral en pacientes VIH+. Psicothema. 2002;14(2):262-267.
12. Remor E, Milner-Moskovics J, Preussler G. Adaptação brasileira do "Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral". Rev Saude Publica. 2007;41(5):685-694.
13. Brasil. Ministério da Saúde. Orientações para abordagem consentida, alerta de má adesão aos antirretrovirais e critério de abandono ao tratamento. Nota técnica 208/09 – UAT/DST. Brasília (DF): Ministério da Saúde; 2009.
14. Beck ST, Cauzzo LDG, Vielmo L, Andrade CS. Perfil de gestantes em tratamento para a infecção pelo vírus da imunodeficiência humana. Revista de Epidemiologia e Controle de Infecção. 2018;8(3):210-215. doi: 10.17058/reci.v8i3.11190.
15. Silva CM, Alves RS, Santos TM, Bragagnollo GR, Tavares CM, Santos AAP. Epidemiological overview of HIV/AIDS in pregnant women from a state of northeastern Brazil. Rev Bras Enferm. 2018;71(1):613-621. doi:10.1590/0034-7167-2017-0495.
16. Barbosa BLFA, Marques AK, Guimarães JV. HIV positive pregnancies and the risk factors related to HIV vertical transmission. Rev Enferm UFPE. 2018;12(1):171-178. doi:10.5205/1981-8963-v12i01a23257p171-178-2018.
17. Trindade LNM, Nogueira LMV, Rodrigues ILA, Ferreira AMR, Corrêa GM, Andrade NCO. Infecção por HIV em gestantes e os desafios para o cuidado pré-natal. Rev Bras Enferm. 2021;74(Suppl 4):e20190784. doi:10.1590/0034-7167-2019-0784.
18. Faria ER, Carvalho FT, Lopes RS, Piccinini CA, Gonçalves TR, Santos BR. Gestação e HIV: preditores da adesão ao tratamento no contexto do pré-natal. Psic Teor Pesq. 2014;30(2):197-203.
19. Medeiros FB, Faria ER, Piccinini CA. Maternidade e HIV: continuidade do tratamento e adesão em mulheres após parto. Psico-USF. 2021;26(1):1-10. doi: 10.1590/1413-82712021260105.
20. Gutierrez EB, Sartori AMC, Schmidt AL, Piloto BM, França BB, Oliveira AS, et al. Measuring adherence to antiretroviral treatment: the role of pharmacy records of drug withdrawals. AIDS Behav. 2012;16(6):1482-1490. doi: 10.1007/s10461-012-0168-3.
21. Henegar CE, Westreich DJ, Maskew M, Miller WC, Brookhart A, Van Rie A. Effect of pregnancy and the postpartum period on adherence to antiretroviral therapy among HIV-infected women established on treatment. J Acquir Immune Defic Syndr. 2015;68(4):477-480. doi:10.1097/QAI.0000000000000501.
22. Schoenherr MR, Santos LA, Remor E, Campanha AM. Pharmaceutical care and evaluation of adherence to antiretroviral therapy in people living with HIV/AIDS. Braz J Pharm Sci. 2022;58:e21101. doi: 10.1590/s2175-97902022e19613
23. Silva RAR, Nelson ARC, Duarte FHS, Prado NCC, Rodrigo JRR, Costa DARS. Avaliação da adesão à terapia antirretroviral em pacientes com AIDS. Rev Fund Care Online. 2017;9(1):15-20. doi: 10.9789/2175-5361.2017.v9i1.15-20.
24. Zuge S, Primeira M, Remor E, Magnano T, Paula C, Padoin S, et al. Fatores associados à adesão ao tratamento antirretroviral em adultos infectados pelo HIV: estudo transversal. Rev Enferm UFSM. 2017;7(4):577-589. https://doi.org/10.5902/2179769225657
25. Goulart S, Meirelles BHS, Costa VT, Pfleger G, Silva LM. Adesão à terapia antirretroviral em adultos com HIV/AIDS atendidos em um serviço de referência. Reme Rev Min Enferm. 2018;22:e-1175. https://doi.org/10.35699/reme.v22i1.49635
26. Tsegaye R, Etafa W, Wakuma B, Mosisa G, Mulisa D, Tolossa T. The magnitude of adherence to option B plus program and associated factors among women in eastern African countries: a systematic review and meta-analysis. BMC Public Health. 2020;20(1):1812. doi:10.1186/s12889-020-09903-y.
27. Aferu T, Doang G, Zewudie A, Nigussie T. Adherence to antiretroviral therapy among HIV-positive pregnant women on follow-up at Mizan Tepi University Teaching and Tepi General Hospitals, Southwest Ethiopia. J Prim Care Community Health. 2020;11:e2150132720974086. doi: 10.1177/2150132720902561
28. Martins RS, Knauth DR, Vigom A, Fish P. Eventos marcadores associados à adesão ao tratamento para HIV/AIDS em um estudo de coorte. Rev Saude Publica. 2023;57:20. doi: 10.11606/s1518-8787.2023057004219.
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