• Citer

Adherence to antiretroviral therapy among HIV-positive women before, during and after pregnancy : a nationwide cohort study in Belgium

par Neven, Anouk
Président du jury Donnen, Philippe
Promoteur Kirakoya, Fati
Publication Non publié, 2023-08-29

Mémoire

• Accès en ligne
• Détails
• Contenu
• Statistiques

Résumé :

Background: In pregnant women living with HIV, optimal adherence to antiretroviral therapy (ART) is crucial to prevent mother-to-child transmission of HIV. Adherence to medication is a dynamic process, however most existing studies are cross-sectional and do not capture the time-varying pattern of adherence. Currently, there is a growing trend to study medication use during pregnancy using linked administrative healthcare databases. The purpose of the present study is to 1) assess the agreement between records of HIV status in different data sources, and 2) classify HIV-positive pregnant women with similar pattern of adherence to ART into different longitudinal trajectories, using the retrospective Belgian national cohort of pregnant women (BeMeP cohort). Methods: We estimated Cohen’s kappa coefficient κ for agreement between the pharmacy prescription and the national statistics (STATBEL) records of HIV status. We measured adherence using the proportion of days covered and considered an adherence threshold of 80%. Group-based trajectory modelling (GBTM) was used to identify different adherence pattern to ART from 28 weeks before pregnancy start to 28 weeks post-delivery. Multinomial logistic regression was performed to assess the association between maternal characteristics and trajectory groups.Results: Of the 843 780 livebirth events in the BeMeP cohort, 937 were associated to HIV-positive mothers and 645 were included in the GBTM analysis. Agreement of HIV status was substantial between both data sources (κ=0.70; 95% CI=0.68, 0.73). Tenofovir disoproxil+emtricitabine+atazanavir was the most frequently prescribed ART combination. GBTM analyses identified four distinct adherence trajectories: consistently high adherence (42.8%), consistently moderate adherence (22.7%), improving adherence during pregnancy (8.4%) and consistently poor adherence (26.1%). Young age was associated with low adherence, when compared to the high adherence group. Conclusions: The present study enabled us to validate for the first time the records of HIV status in the STATBEL versus the healthcare consumption databases. The GBTM method highlights that adherence remains a challenge and public health concern, with approximately one in four women reporting consistently poor adherence throughout the entire study period. Administrative health databases can be used, with rigorous methodology, for adherence monitoring in women who receive ART.Key words: pregnancy, HIV, antiretroviral therapy, medication adherence, health administrative data, trajectory analysis.