This study compared adherence (persistence and execution) during
pregnancy and postpartum in HIV-positive women having taken part
in the adherence-enhancing program of the Community Pharmacy of
the Department of Ambulatory Care and Community Medicine in
Lausanne between 2004 and 2012. This interdisciplinary program
combined electronic drug monitoring and semi-structured, repeated
motivational interviews. This was a retrospective, observational study.
Observation period spread over from first adherence visit after last
menstruation until 6 months after childbirth. Medication-taking was
recorded by electronic drug monitoring. Socio-demographic and
delivery data were collected from Swiss HIV Cohort database.
Adherence data, barriers and facilitators were collected from
pharmacy database. Electronic data were reconciled with pill-count
and interview notes in order to include reported pocket-doses.
Execution was analyzed over 3-day periods by a mixed effect logistic
model, separating time before and after childbirth. This model allowed
us to estimate different time slopes for both periods and to show a
sudden fall associated with childbirth. Twenty-five pregnant women
were included. Median age was 29 (IQR: 26.5, 32.0), women were in
majority black (n_17,68%) and took a cART combining protease and
nucleoside reverse transcriptase inhibitors (n_24,96%). Eleven
women (44%) were ART-naı¨ve at the beginning of pregnancy. Twenty
women (80%) were included in the program because of pregnancy.
Women were included at all stages of pregnancy. Six women (24%)
stopped the program during pregnancy, 3 (12%) at delivery, 4 (16%)
during postpartum and 12 (48%) stayed in program at the end of
observation time. Median number of visits was 4 (3.0, 6.3) during
pregnancy and 3 (0.8, 6.0) during postpartum. Execution was
continuously high during pregnancy, low at beginning of postpartum
and increased gradually during the 6 months of postpartum.
Major barriers to adherence were medication adverse events and
difficulties in daily routine. Facilitators were motivation for promoting
child-health and social support. The dramatic drop and very slow
increase in cART adherence during postpartum might result in viral
rebound and drug resistance. Although much attention is devoted to
pregnant women, interdisciplinary care should also be provided
to women in the community during first trimester of postpartum to
support them in sustaining cART adherence.