Universal ART: uptake remains low among asymptomatic pregnant women

  • Stranix-Chibanda L & al.
  • AIDS Behav
  • 9 Aug 2019

  • International Clinical Digest
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Takeaway

  • Despite WHO universal antiretroviral therapy (ART) guidelines, process of initiating ART remains separate from overcoming challenges/barriers to lifelong adherence.
  • Ample resources alone are insufficient to encourage universal ART uptake among asymptomatic, HIV-infected women.

Why this matters

  • Consider sociocultural barriers to ART acceptance, including negative stigma, male partner attitudes/violence/exclusion.
  • Provide time for infected women to consult partners, discuss questions/fears.
  • Consider waning ART adherence; regular monitoring, follow-up counselling essential.

Key results

  • Among 84% (4512/5400) PROMISE participants enrolled, 93% (4211) underwent at least 1 standardised counseling session.
  • Counseling yielded 65.5% (95% CI, 63%-68%) universal ART uptake.
  • Probability of uptake increased with number of counseling sessions from 2 (82.6%) to 3 (87.5%) and 6 sessions (94.4%).
  • Primary reasons for declining ART: wanting more consideration time (44%), feeling well/high CD4 count (19%).
  • 95/201 cited need to consider significant other (34%, 32), psychological unpreparedness (26%, 25).
  • Reasons for accepting: concern about health (46%), recommendations (36%), CD4 count concerns (16%).

Study design

  • IMPAACT PROMISE study (Africa, Asia, South/North America) subgroup analysis evaluating universal ART uptake, rationale for/against acceptance among HIV-infected pregnant, postpartum women.
  • Funding: NIH.

Limitations

  • Uncontrolled response timing.
  • Subsequent counselling sessions not standardised.
  • Qualitative data lacking.

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