Younger mothers struggle with HIV treatment adherence following birth of baby
Two-thirds of South African mothers living with HIV are on effective treatment following the birth of their child, but only one-third of younger mothers are.
In a new study from Eastern Cape, South Africa, researchers sought to understand adherence to antiretroviral treatment (ART) among women living with HIV in the postnatal period.
Adherence to ART among pregnant women living with HIV tends to peak during pregnancy then decline after giving birth. For instance, a 2018 study found only half of HIV-positive women in sub-Saharan Africa were virally suppressed 12 months after giving birth. As women living with HIV in sub-Saharan Africa are advised to breastfeed for between six months and two years after birth, this period is when most maternally transmitted HIV infections now occur. Despite this, most mother-to-child transmission studies tend to focus on women when they are pregnant.
To examine levels of ART adherence and what factors could determine this, 485 HIV-positive women from the Eastern Cape in South Africa were interviewed in 2018, all of whom had given birth between 18 and 24 months previously.
Six questions relating to socio-demographic factors, lifestyle and adherence to ART were asked to probe participants’ treatment levels since giving birth. Adherence was defined as 100% consistent daily use of ART. The study did not take into account whether medication was taken at different times each day.
Around 64% of participants reported complete adherence, but rates varied significantly between demographic groups.
Adherence was lowest among young women (aged 24 and under), with only 36% adhering to treatment. When analysing by age, younger mothers were 70% less likely to adhere to ART than mothers aged 40 and over. This may be reflective of the fact that young people in general face greater challenges in adhering to ART for various social and structural reasons.
Alcohol use was also identified as a factor in poor adherence. Women who drank alcohol were found to be 53% less likely to adhere to treatment compared to non-drinkers.
A higher level of adherence was reported among women who had disclosed their HIV status to their partner (66%) and those who knew their partner’s status (69%). Overall, women who knew their partner’s status were twice as likely to adhere to ART as those who did not.
The study did not find a significant link between ART adherence and the length that women breastfed for. This is contrary to previous studies that have found breastfeeding duration to be positively associated with ART adherence. This may be due to the fact that breastfeeding is common in South Africa and so may not be a good predictor of other behaviours, including adherence.
The findings suggest that, in South Africa and in similar contexts, designing and strengthening interventions that meet the needs of young mothers and new mothers who drink alcohol could help to increase ART adherence among women living with HIV, which may, in turn, reduce maternal transmission. Disclosure of HIV status should also be encouraged between partners to enable new mothers living with HIV a better chance of taking ART effectively.