Antiretroviral therapy adherence among peripartum women with HIV in Kenya: an explanatory mixed methods study using dry blood spot measures and narrative interviews

ABSTRACT

Adherence to antiretroviral therapy (ART) remains sub-optimal among pregnant and postpartum women with HIV (PPWH) in high HIV prevalence low resource settings with few effective behavioral interventions. A large body of qualitative literature has established general barriers and facilitators to ART adherence in PPWH at various levels (individual, interpersonal, structural). However, research exploring the underlying behavioral mechanisms of ART adherence in PPWH with objectively verified adherence biomarkers is extremely limited. We conducted 24 in-depth interviews with postpartum women in western Kenya who had linked ART drug concentrations obtained from three dried blood spot samples across the peripartum period. Among PPWH with a low drug concentration (n = 13) compared to those with continuously high drug concentrations (n = 11), distinct themes emerged related to HIV status disclosure, social support, interactions with the health system, and health beliefs. By combining ART biomarkers with patient reported challenges, there is the potential for real-time interventions to support sustained ART adherence among PPWH and improve maternal and infant health outcomes.

KEYWORDS:

• Antiretroviral therapy
• prevention of mother-to-child transmission
• Tenofovir-diphosphate
• dry blood spot
• Sub-Saharan Africa

Sustainable Development Goals:

• SDG 3: Good health and well-being

Acknowledgements

Funding for the study was support by the National Institute of Allergy and Infectious Diseases (T32AI007447) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD080477-04S1) of the National Institutes of Health.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development: [Grant Number R01 HD080477-04S1]; National Institute of Allergy and Infectious Diseases: [Grant Number T32AI007447].