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Self-Report and Dry Blood Spot Measurement of Antiretroviral Medications as Markers of Adherence in Pregnant Women in Rural South Africa

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Abstract

Antiretroviral (ARV) adherence is essential to prevent mother-to-child transmission of HIV. This study compared self-reported adherence versus ARV detection in dried blood spots (DBS) among N = 392 HIV-infected pregnant women in South Africa (SA). Women completed two self-reported adherence measures [visual analog scale (VAS), AIDS Clinical Trials Group Adherence (ACTG)]. Adherence was 89% (VAS), 80% (ACTG), and 74% (DBS). Self-report measures marginally agreed with DBS (VAS: Kappa = 0.101, Area under the ROC curve (AUROC) = 0.543; ACTG: Kappa  = 0.081, AUROC = 0.538). Self-reported adherence was overestimated and agreement with DBS was poor. Validation of self-reported ARV adherence among pregnant HIV+ women in SA is needed.

Resumen

La adherencia a los antirretrovirales es esencial para prevenir la transmisión perinatal del VIH. Este studio compara la adherencia autoreportada frente a la detección de ARV en muestras de sangre secas (Dry Blood Spot o DBS) en 392 mujeres embarazadas infectadas con VIH (VIH +) en Sudáfrica. Las participantes completaron dos medidas de adherencia autoreportada [Escala Visual Analógica (EVA), Grupo de Ensayos Clínicos del SIDA (GECS)] en la semana 32 de embarazo. La proporción de mujeres adherentes fue 89% (EVA), 80% (GECS) y 74% (GSS). La concordancia entre las medidas de auto-reporte y GSS fue baja (EVA: κ = 0,101, AUROC = 0,543; GECS: κ = 0,081, AUROC = 0,538). La adherencia autoreportada sobreestima adherencia cuando es comparada con DBS. La concordancia de medidas autoreportadas y DBS es baja. Es necesario desarollar nuevas medidas para evaluar adherencia a antiretrovirales en mujeres embarazadas que son VIH+ para prevenir transmisión perinatal del VIH.

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Funding

This study was funded by a collaborative NIH/PEPFAR Grant, R01HD078187-S. Activities were conducted with the support of the University of Miami Miller School of Medicine Center for AIDS Research, funded by an NIH grant, P30AI073961 and K23HD074489.

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Correspondence to Maria L. Alcaide.

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All authors declare that they have no conflicts of interest.

Ethical Approval

Ethical approval was granted by the Human Sciences Research Council (HSRC) Research Ethics Committee (REC), protocol approval number REC4/21/08/13. Study approval was also obtained from the Department of Health REC, Mpumalanga Provincial Government, South Africa and the University of Miami Miller School of Medicine Institutional Review Board. All procedures performed in studies involving human participants were also in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Voluntary informed consent was provided by all individual participants prior to enrollment and participation in any study procedures.

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Alcaide, M.L., Ramlagan, S., Rodriguez, V.J. et al. Self-Report and Dry Blood Spot Measurement of Antiretroviral Medications as Markers of Adherence in Pregnant Women in Rural South Africa. AIDS Behav 21, 2135–2140 (2017). https://doi.org/10.1007/s10461-017-1760-3

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