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AIDS and Behavior

, Volume 23, Issue 12, pp 3247–3256 | Cite as

Alcohol, But Not Depression or IPV, Reduces HIV Adherence Among South African Mothers Living with HIV Over 5 Years

  • Mary Jane Rotheram-BorusEmail author
  • Thomas W. Weichle
  • Adriane Wynn
  • Ellen Almirol
  • Emily Davis
  • Jacqueline Stewart
  • Sarah Gordon
  • Julia Tubert
  • Mark Tomlinson
Original Paper

Abstract

Alcohol, depression, and intimate partner violence (IPV) are endemic in sub-Saharan Africa. This article examines whether and how these conditions affect mothers living with HIV (MLH), compared to mothers without HIV (MWOH). In particular, we assess the influence of these comorbidities on engagement in HIV care and adherence to antiretroviral therapies (ARV) among MLH. Data on maternal HIV care are typically based on clinic samples, with substantial loss to follow-up. This study fills that gap by including all mothers in specified areas. A cohort study examines MLH in Cape Town, South Africa recruited in pregnancy and followed repeatedly for 5 years, compared to MWOH. Almost all (98%) pregnant women in 12 neighborhoods (N = 594) were recruited in pregnancy. Mothers and children were reassessed five times over 5 years with high retention rates at each of the six assessments, from 98.7% at 2 weeks to 82.8% at 5 years post-birth. MLH’s uptake and adherence to HIV care was evaluated over time associated with maternal comorbidities of alcohol use, depressed mood, and IPV using mixed effects logistic regression. MLH have fewer resources (income, food, education) and are more likely to face challenges from alcohol, depression, and having seropositive partners over time than MWOH. Only 22.6% of MLH were consistently engaged in HIV care from 6 months to 5 years post-birth. At 5 years, 86.7% self-reported engaged in HIV care, 76.9% were receiving ARVs and 87% of those on ARV reported consistent ARV adherence. However, data on viral suppression are unavailable. Alcohol use, but not depressed mood or IPV, was significantly related to reduced uptake of HIV care and adherence to ARV over time. Adherence to lifelong ARV by MLH requires a combination of structural and behaviorally-focused interventions. Alcohol abuse is not typically addressed in low and middle-income countries, but is critical to support MLH.

Keywords

Alcohol use HIV Depression Intimate partner violence Adherence 

Notes

Acknowledgments

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (R01AA017104, R24AA022919), National Institute of Mental Health (P30MH058107), Ilifa Labantwana, National Institute of Allergy and Infectious Diseases (AI028697), and the National Center for Advancing Translational Science (UL1TR000124). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

10461_2019_2617_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 kb)

References

  1. 1.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). The global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Geneva, Switzerland. 2016. http://www.unaids.org/sites/default/files/media_asset/GlobalPlan2016_en.pdf. Accessed 29 Jan 2019.
  2. 2.
    Sibanda EL, Weller IV, Hakim JG, Cowan FM. The magnitude of loss to follow-up of HIV-exposed infants along the prevention of mother-to-child HIV transmission continuum of care: a systematic review and meta-analysis. Aids. 2013;27(17):2787–97.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Clouse K, Pettifor A, Shearer K, et al. Loss to follow-up before and after delivery among women testing HIV positive during pregnancy in Johannesburg, South Africa. Trop Med Int Health. 2013;18(4):451–60.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Phillips T, Thebus E, Bekker LG, Mcintyre J, Abrams EJ, Myer L. Disengagement of HIV-positive pregnant and postpartum women from antiretroviral therapy services: a cohort study. J Int AIDS Soc. 2014;17(1):19242.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Haas AD, Tenthani L, Msukwa MT, et al. Retention in care during the first 3 years of antiretroviral therapy for women in Malawi’s option B+ programme: an observational cohort study. The Lancet HIV. 2016;3(4):e175–82.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Woelk GB, Ndatimana D, Behan S, et al. Retention of mothers and infants in the prevention of mother-to-child transmission of HIV programme is associated with individual and facility-level factors in Rwanda. J Int AIDS Soc. 2016;19:20837.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Gumede-Moyo S, Filteau S, Munthali T, Todd J, Musonda P. Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: a systematic literature review. Medicine. 2017;96(40):e8055.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Decker S, Rempis E, Schnack A, et al. Prevention of mother-to-child transmission of HIV: postpartum adherence to Option B+ until 18 months in Western Uganda. PLoS ONE. 2017;12(6):e0179448.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Myer L, Phillips TK, Hsiao NY, et al. Plasma viraemia in HIV-positive pregnant women entering antenatal care in South Africa. J Int AIDS Soc. 2015;18(1):20045.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Myer L, Dunning L, Lesosky M, et al. Frequency of viremic episodes in HIV-infected women initiating antiretroviral therapy during pregnancy: a cohort study. Clin Infect Dis. 2017;64(4):422–7.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Myer L, Phillips TK, Zerbe A, et al. Integration of postpartum healthcare services for HIV-infected women and their infants in South Africa: a randomised controlled trial. PLoS Med. 2018;15(3):e1002547.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Joint United Nations Programme on HIV/AIDS (UNAIDS). 90–90–90: an ambitious treatment target to help end the AIDS epidemic. Geneva, Switzerland. 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf. Accessed 29 Jan 2019.
  13. 13.
    Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retrovir. 2010;26(5):511–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL. The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav. 2006;10(3):253–61.PubMedCrossRefGoogle Scholar
  15. 15.
    Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103(4):698–709.PubMedCrossRefGoogle Scholar
  16. 16.
    Devries KM, Mak JYT, García-Moreno C, et al. The global prevalence of intimate partner violence against women. Science. 2013;340(6140):1527–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Jewkes R, Dunkle K, Nduna M, Shai N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study. The Lancet. 2010;376(9734):41–8.CrossRefGoogle Scholar
  18. 18.
    Kiene SM, Lule H, Sileo KM, Silmi KP, Wanyenze RK. Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior. BMC Infect Dis. 2017;17(1):88.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Jasseron C, Mandelbrot L, Dollfus C, et al. Non-disclosure of a pregnant woman’s HIV status to her partner is associated with non-optimal prevention of mother-to-child transmission. AIDS Behav. 2013;17(2):488–97.PubMedCrossRefGoogle Scholar
  20. 20.
    Magidson JF, Saal W, Nel A, Remmert JE, Kagee A. Relationship between depressive symptoms, alcohol use, and antiretroviral therapy adherence among HIV-infected, clinic-attending patients in South Africa. J Health Psychol. 2016;22(11):1426–33.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Morajele N, Kekwaletswe C, Nkosi S. Associations between alcohol use, other psychosocial factors, structural factors and antiretroviral therapy (ART) adherence among South African ART recipients. AIDS Behav. 2014;18(3):519–24.CrossRefGoogle Scholar
  22. 22.
    Seth P, Kidder D, Pals S, et al. Psychosocial functioning and depressive symptoms among HIV-positive persons receiving care and treatment in Kenya, Namibia, and Tanzania. Prev Sci. 2014;15(3):318–28.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Rotheram-Borus MJ, le Roux IM, Tomlinson M, et al. Philani Plus (+): a Mentor Mother community health worker home visiting program to improve maternal and infants’ outcomes. Prev Sci. 2011;12(4):372.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    South Africa National Department of Health. Policy and Guidelines of the Implementation of the PMTCT Programme. 2008. https://www.ilo.org/wcmsp5/groups/public/—ed_protect/—protrav/—ilo_aids/documents/legaldocument/wcms_125633.pdf. Accessed 29 Jan 2019.
  25. 25.
    South Africa National Department of Health. South African Antiretroviral Treatment Guidelines. 2010. http://apps.who.int/medicinedocs/documents/s19153en/s19153en.pdf. Accessed 29 Jan 2019.
  26. 26.
    Tsai AC, Bangsberg DR, Emenyonu N, Senkungu JK, Martin JN, Weiser SD. The social context of food insecurity among persons living with HIV/AIDS in rural Uganda. Soc Sci Med. 2011;73(12):1717–24.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT, the alcohol use disorders identification test: Guidelines for use in primary care. Genevea, Switzerland: World Health Organization, Dept. of Mental Health and Substance Dependence; 2001. https://apps.who.int/iris/bitstream/handle/10665/67205/WHO_MSD_MSB_01.6a.pdf;jsessionid=A0895B346180CE265D51A032E7901B92?sequence=1. Accessed 29 Jan 2019.
  28. 28.
    Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression—development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Lawrie TA, Hofmeyr GJ, de Jager M. Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. S Afr Med J. 1998;88(10):1340–4.PubMedGoogle Scholar
  30. 30.
    Fisher JC, Bang H, Kapiga SH. The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies. Sex Transm Dis. 2007;34(11):856–63.PubMedCrossRefGoogle Scholar
  31. 31.
    Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8(2):141.PubMedCrossRefGoogle Scholar
  32. 32.
    Murphy DA, Austin EL, Greenwell L. Correlates of HIV-related stigma among HIV-positive mothers and their uninfected adolescent children. Women Health. 2007;44(3):19–42.CrossRefGoogle Scholar
  33. 33.
    Kaida A, Matthews LT, Ashaba S, et al. Depression during pregnancy and the postpartum among HIV-infected women on antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr. 2014;67(4):179–87.CrossRefGoogle Scholar
  34. 34.
    Kapetanovic S, Dass-Brailsford P, Nora D, Talisman N. Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. AIDS Behav. 2015;18(6):1152–73.CrossRefGoogle Scholar
  35. 35.
    Li Y, Marshall CM, Rees HC, Nunez A, Ezeanolue EE, Ehiri JE. Intimate partner violence and HIV infection among women: a systematic review and meta-analysis. J Int AIDS Soc. 2014;17(1):18845.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Russell BS, Eaton LA, Petersen-Williams P. Intersecting epidemics among pregnant women: alcohol use, interpersonal violence, and HIV infection in South Africa. Curr HIV/AIDS Rep. 2013;10(1):103–10.PubMedPubMedCentralCrossRefGoogle Scholar
  37. 37.
    Gibbs Andrew, Dunkle Kristin, Willan Samantha, Jama-Shai Nwabisa, Washington Laura, Jewkes Rachel. Are women’s experiences of emotional and economic intimate partner violence associated with HIV-risk behaviour? A cross-sectional analysis of young women in informal settlements in South Africa. AIDS Care. 2019;31(6):667–74.PubMedCrossRefGoogle Scholar
  38. 38.
    Burton R, Giddy J, Stinson K. Prevention of mother-to-child transmission in South Africa: an ever-changing landscape. Obstet Med. 2015;8(1):5–12.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Matsui D. Adherence with drug therapy in pregnancy. Obstet Gynecol Int. 2012.  https://doi.org/10.1155/2012/796590.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic review. Curr HIV/AIDS Rep. 2015;12(4):421–36.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Langebeek N, Gisolf EH, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12(1):142.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Loftus H, Burnett A, Naylor S, Bates S, Greig J. HIV control in postpartum mothers: a turbulent time. Int J STD AIDS. 2016;27(8):680–3.PubMedCrossRefGoogle Scholar
  43. 43.
    Hatcher AM, Stöckl H, Christofides N, et al. Mechanisms linking intimate partner violence and prevention of mother-to-child transmission of HIV: a qualitative study in South Africa. Soc Sci Med. 2016;168:130–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Barry MM, Clarke AM, Jenkins R, Patel V. A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health. 2013;13:835.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Bhana A, Mellins CA, Petersen I, et al. The VUKA family program: piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care. 2014;26(1):1–11.PubMedCrossRefGoogle Scholar
  46. 46.
    Carrasco MA, Esser MB, Sparks A, Kaufman MR. HIV-alcohol risk reduction interventions in Sub-Saharan Africa: a systematic review of the literature and recommendations for a Way forward. AIDS Behav. 2016;20(3):484–503.PubMedCrossRefGoogle Scholar
  47. 47.
    Parry CD. South Africa: alcohol today. Addiction. 2005;100(4):426–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Rotheram-Borus MJ, Tomlinson M, Weichle TW, Stewart J, Gordon S. (2018, July). South African Mothers Living with HIV (MLH) do not sustain HIV care 5 years post-birth, especially when problematic alcohol use occurs. International AIDS Society, Amsterdam.Google Scholar
  49. 49.
    Tomlinson M, Rotheram-Borus, MJ. Evaluating the Philani Project. Meeting of Health Care Funders in South Africa, held at the Philani Organization in Khayelitsha, Cape Town. 2018.Google Scholar
  50. 50.
    National Department of Health. The 2012 National Antenatal Sentinel HIV & Herpes Simplex Type-2 Prevalence Survey in South Africa. Pretoria, South Africa: National Department of Health. 2014. https://www.health-e.org.za/wp-content/uploads/2014/05/ASHIVHerp_Report2014_22May2014.pdf. Accessed 29 Jan 2019.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Biobehavioral Sciences, Semel InstituteUniversity of California at Los AngelesLos AngelesUSA
  2. 2.Institute for Life Course Health Research, Department of Global HealthStellenbosch UniversityCape TownSouth Africa
  3. 3.Division of Infectious Diseases & Global Public Health, School of MedicineUCSDLa JollaUSA
  4. 4.School of Nursing and MidwiferyQueens UniversityBelfastUK

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