Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya

Paul Ayuo, Beverly Musick, Hai Liu, Paula Braitstein, Winstone Nyandiko, Boaz Otieno-Nyunya, Adrian Gardner, Kara Wools-Kaloustian

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Introduction: The objective of this analysis was to identify points of disruption within the prevention of mother-to-child transmission (PMTCT) continuum from combination antiretroviral therapy (CART) initiation until delivery. Methods: To address this objective, the electronic medical records of all antiretroviral-naïve adult pregnant women who were initiating CART for PMTCT between January 2006 and February 2009 within the Academic Model Providing Access To Healthcare (AMPATH), western Kenya, were reviewed. Outcomes of interest were clinician-initiated change or stop in regimen, disengagement from programme (any, early, late) and self-reported medication adherence. Disengagement was categorized as early disengagement (any interval of greater than 30 days between visits but returning to care prior to delivery) or late disengagement (no visit within 30 days prior to the date of delivery). The association between covariates and the outcomes of interest were assessed using bivariate (Kruskal-Wallis test for continuous variables and the Chi-square test for categorical variables) and multivariate logistic regression analysis. Results: A total of 4284 antiretroviral-naïve pregnant women initiated CART between January 2006 and February 2009. The majority of women (89%) reported taking all of their medication at every visit. There were 18 (0.4%) deaths reported. Clinicians discontinued CART in 10 patients (0.7%) while 1367 (31.9%) women disengaged from care. Of those disengaging, 404 (29.6%) disengaged early and 963 (70.4%) late. In the multivariate model, the odds of disengagement decreased with increasing age (odds ratio [OR] 0.982; confidence interval [CI] 0.966-0.998) and increasing gestational age at CART initiation (OR 0.925; CI 0.909-0.941). Women receiving care at a district hospital (OR 0.794; CI 0.644-0.980) or tuberculosis medication (OR 0.457; CI 0.202-0.935) were less likely to disengage. The odds of disengagement were higher in married women (OR 1.277; CI 1.034-1.584). The odds of early disengagement decreased with increasing age at CART initiation (OR 0.902; CI 0.881-0.924). The odds of late disengagement decreased with increasing age at CART initiation (OR 0.936; CI 0.917-0.956). While they increased with higher CD4 counts at CART-initiation (OR 1.001; CI 1.000-1001) and in married women (OR 1.297; CI 1.000-1.695) Conclusions: In a PMTCT programme embedded in an antiretroviral treatment programme with an active outreach department, the majority (67.4%) of women remained engaged and received uninterrupted prenatal CART.

Original languageEnglish
Article number17994
JournalJournal of the International AIDS Society
Volume16
DOIs
StatePublished - Jan 2 2013

Fingerprint

Kenya
Mothers
Odds Ratio
Confidence Intervals
Therapeutics
Pregnant Women
Medication Adherence
District Hospitals
Electronic Health Records
Chi-Square Distribution
CD4 Lymphocyte Count
Gestational Age
Tuberculosis
Logistic Models
Regression Analysis
Delivery of Health Care

Keywords

  • Adherence
  • Combination antiretroviral therapy (CART)
  • HIV
  • Pregnancy
  • Prevention of mother-to-child transmission (PMTCT)

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health

Cite this

Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya. / Ayuo, Paul; Musick, Beverly; Liu, Hai; Braitstein, Paula; Nyandiko, Winstone; Otieno-Nyunya, Boaz; Gardner, Adrian; Wools-Kaloustian, Kara.

In: Journal of the International AIDS Society, Vol. 16, 17994, 02.01.2013.

Research output: Contribution to journalArticle

@article{17cecabd86ea47a0978cb411ead31ca9,
title = "Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya",
abstract = "Introduction: The objective of this analysis was to identify points of disruption within the prevention of mother-to-child transmission (PMTCT) continuum from combination antiretroviral therapy (CART) initiation until delivery. Methods: To address this objective, the electronic medical records of all antiretroviral-na{\"i}ve adult pregnant women who were initiating CART for PMTCT between January 2006 and February 2009 within the Academic Model Providing Access To Healthcare (AMPATH), western Kenya, were reviewed. Outcomes of interest were clinician-initiated change or stop in regimen, disengagement from programme (any, early, late) and self-reported medication adherence. Disengagement was categorized as early disengagement (any interval of greater than 30 days between visits but returning to care prior to delivery) or late disengagement (no visit within 30 days prior to the date of delivery). The association between covariates and the outcomes of interest were assessed using bivariate (Kruskal-Wallis test for continuous variables and the Chi-square test for categorical variables) and multivariate logistic regression analysis. Results: A total of 4284 antiretroviral-na{\"i}ve pregnant women initiated CART between January 2006 and February 2009. The majority of women (89{\%}) reported taking all of their medication at every visit. There were 18 (0.4{\%}) deaths reported. Clinicians discontinued CART in 10 patients (0.7{\%}) while 1367 (31.9{\%}) women disengaged from care. Of those disengaging, 404 (29.6{\%}) disengaged early and 963 (70.4{\%}) late. In the multivariate model, the odds of disengagement decreased with increasing age (odds ratio [OR] 0.982; confidence interval [CI] 0.966-0.998) and increasing gestational age at CART initiation (OR 0.925; CI 0.909-0.941). Women receiving care at a district hospital (OR 0.794; CI 0.644-0.980) or tuberculosis medication (OR 0.457; CI 0.202-0.935) were less likely to disengage. The odds of disengagement were higher in married women (OR 1.277; CI 1.034-1.584). The odds of early disengagement decreased with increasing age at CART initiation (OR 0.902; CI 0.881-0.924). The odds of late disengagement decreased with increasing age at CART initiation (OR 0.936; CI 0.917-0.956). While they increased with higher CD4 counts at CART-initiation (OR 1.001; CI 1.000-1001) and in married women (OR 1.297; CI 1.000-1.695) Conclusions: In a PMTCT programme embedded in an antiretroviral treatment programme with an active outreach department, the majority (67.4{\%}) of women remained engaged and received uninterrupted prenatal CART.",
keywords = "Adherence, Combination antiretroviral therapy (CART), HIV, Pregnancy, Prevention of mother-to-child transmission (PMTCT)",
author = "Paul Ayuo and Beverly Musick and Hai Liu and Paula Braitstein and Winstone Nyandiko and Boaz Otieno-Nyunya and Adrian Gardner and Kara Wools-Kaloustian",
year = "2013",
month = "1",
day = "2",
doi = "10.7448/IAS.16.1.17994",
language = "English",
volume = "16",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",

}

TY - JOUR

T1 - Frequency and factors associated with adherence to and completion of combination antiretroviral therapy for prevention of mother to child transmission in western Kenya

AU - Ayuo, Paul

AU - Musick, Beverly

AU - Liu, Hai

AU - Braitstein, Paula

AU - Nyandiko, Winstone

AU - Otieno-Nyunya, Boaz

AU - Gardner, Adrian

AU - Wools-Kaloustian, Kara

PY - 2013/1/2

Y1 - 2013/1/2

N2 - Introduction: The objective of this analysis was to identify points of disruption within the prevention of mother-to-child transmission (PMTCT) continuum from combination antiretroviral therapy (CART) initiation until delivery. Methods: To address this objective, the electronic medical records of all antiretroviral-naïve adult pregnant women who were initiating CART for PMTCT between January 2006 and February 2009 within the Academic Model Providing Access To Healthcare (AMPATH), western Kenya, were reviewed. Outcomes of interest were clinician-initiated change or stop in regimen, disengagement from programme (any, early, late) and self-reported medication adherence. Disengagement was categorized as early disengagement (any interval of greater than 30 days between visits but returning to care prior to delivery) or late disengagement (no visit within 30 days prior to the date of delivery). The association between covariates and the outcomes of interest were assessed using bivariate (Kruskal-Wallis test for continuous variables and the Chi-square test for categorical variables) and multivariate logistic regression analysis. Results: A total of 4284 antiretroviral-naïve pregnant women initiated CART between January 2006 and February 2009. The majority of women (89%) reported taking all of their medication at every visit. There were 18 (0.4%) deaths reported. Clinicians discontinued CART in 10 patients (0.7%) while 1367 (31.9%) women disengaged from care. Of those disengaging, 404 (29.6%) disengaged early and 963 (70.4%) late. In the multivariate model, the odds of disengagement decreased with increasing age (odds ratio [OR] 0.982; confidence interval [CI] 0.966-0.998) and increasing gestational age at CART initiation (OR 0.925; CI 0.909-0.941). Women receiving care at a district hospital (OR 0.794; CI 0.644-0.980) or tuberculosis medication (OR 0.457; CI 0.202-0.935) were less likely to disengage. The odds of disengagement were higher in married women (OR 1.277; CI 1.034-1.584). The odds of early disengagement decreased with increasing age at CART initiation (OR 0.902; CI 0.881-0.924). The odds of late disengagement decreased with increasing age at CART initiation (OR 0.936; CI 0.917-0.956). While they increased with higher CD4 counts at CART-initiation (OR 1.001; CI 1.000-1001) and in married women (OR 1.297; CI 1.000-1.695) Conclusions: In a PMTCT programme embedded in an antiretroviral treatment programme with an active outreach department, the majority (67.4%) of women remained engaged and received uninterrupted prenatal CART.

AB - Introduction: The objective of this analysis was to identify points of disruption within the prevention of mother-to-child transmission (PMTCT) continuum from combination antiretroviral therapy (CART) initiation until delivery. Methods: To address this objective, the electronic medical records of all antiretroviral-naïve adult pregnant women who were initiating CART for PMTCT between January 2006 and February 2009 within the Academic Model Providing Access To Healthcare (AMPATH), western Kenya, were reviewed. Outcomes of interest were clinician-initiated change or stop in regimen, disengagement from programme (any, early, late) and self-reported medication adherence. Disengagement was categorized as early disengagement (any interval of greater than 30 days between visits but returning to care prior to delivery) or late disengagement (no visit within 30 days prior to the date of delivery). The association between covariates and the outcomes of interest were assessed using bivariate (Kruskal-Wallis test for continuous variables and the Chi-square test for categorical variables) and multivariate logistic regression analysis. Results: A total of 4284 antiretroviral-naïve pregnant women initiated CART between January 2006 and February 2009. The majority of women (89%) reported taking all of their medication at every visit. There were 18 (0.4%) deaths reported. Clinicians discontinued CART in 10 patients (0.7%) while 1367 (31.9%) women disengaged from care. Of those disengaging, 404 (29.6%) disengaged early and 963 (70.4%) late. In the multivariate model, the odds of disengagement decreased with increasing age (odds ratio [OR] 0.982; confidence interval [CI] 0.966-0.998) and increasing gestational age at CART initiation (OR 0.925; CI 0.909-0.941). Women receiving care at a district hospital (OR 0.794; CI 0.644-0.980) or tuberculosis medication (OR 0.457; CI 0.202-0.935) were less likely to disengage. The odds of disengagement were higher in married women (OR 1.277; CI 1.034-1.584). The odds of early disengagement decreased with increasing age at CART initiation (OR 0.902; CI 0.881-0.924). The odds of late disengagement decreased with increasing age at CART initiation (OR 0.936; CI 0.917-0.956). While they increased with higher CD4 counts at CART-initiation (OR 1.001; CI 1.000-1001) and in married women (OR 1.297; CI 1.000-1.695) Conclusions: In a PMTCT programme embedded in an antiretroviral treatment programme with an active outreach department, the majority (67.4%) of women remained engaged and received uninterrupted prenatal CART.

KW - Adherence

KW - Combination antiretroviral therapy (CART)

KW - HIV

KW - Pregnancy

KW - Prevention of mother-to-child transmission (PMTCT)

UR - http://www.scopus.com/inward/record.url?scp=84879561780&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879561780&partnerID=8YFLogxK

U2 - 10.7448/IAS.16.1.17994

DO - 10.7448/IAS.16.1.17994

M3 - Article

C2 - 23336727

AN - SCOPUS:84879561780

VL - 16

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

M1 - 17994

ER -