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Meta-Analysis
. 2012 Oct 23;26(16):2039-52.
doi: 10.1097/QAD.0b013e328359590f.

Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis

Jean B Nachega  1 , Olalekan A Uthman, Jean Anderson, Karl Peltzer, Sarah Wampold, Mark F Cotton, Edward J Mills, Yuh-Shan Ho, Jeffrey S A Stringer, James A McIntyre, Lynne M Mofenson
Affiliations
Meta-Analysis

Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis

Jean B Nachega et al. AIDS. .

Abstract

Objective: To estimate antiretroviral 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 20 153 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 (CI) 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% CI 71.5-79.7%) than during postpartum (53.0%, 95% CI 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.

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Conflict of interest statement

Conflict of Interest/Disclosures: None

Figures

Figure 1
Figure 1
Study selection flow diagram
Figure 2
Figure 2
Pooled proportion of pregnant women to antiretroviral therapy
Figure 3
Figure 3
Pooled proportion of pregnant women to antiretroviral therapy, by different sub-groups cART: combined antiretroviral therapy, sdNVP: single dose nevirapine, ZDV: Zidovudine
Figure 4
Figure 4
Association between maternal antiretroviral therapy adherence rates and mother-to-child transmission rates
See this image and copyright information in PMC

References

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