Tenofovir Diphosphate in Dried Blood Spots in Pregnant and Postpartum Women With HIV in Kenya: A Novel Approach to Measuring Peripartum Adherence. (1st March 2022)

• Record Type: Journal Article
• Authors: Abuogi, Lisa L.; Castillo-Mancilla, Jose; Hampanda, Karen; Owuor, Kevin; Odwar, Tobias; Onono, Maricianah; Helova, Anna; Turan, Janet M.; Anderson, Peter L.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 89:Number 3(2022)
• Publication Date: 2022-03-01
• Subjects: adherence -- women living with HIV -- prevention of mother to child transmission; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002859
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Adherence to antiretroviral therapy (ART) among pregnant and postpartum women with HIV (PWLWH) is critical to promote maternal health and prevent HIV transmission. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is an objective assessment of cumulative ART adherence that has not been fully assessed in PWLWH. Setting: Southwestern Kenya. Methods: PWLWH receiving tenofovir disoproxil fumarate-based ART from 24 health facilities provided DBS samples at 3 time points [pregnancy/early postpartum (PP), 6 months PP, and 9–12 months PP]. Thresholds for daily adherence were defined as TFV-DP in DBS ≥650 fmol/punch in pregnancy and ≥950 PP. Descriptive analysis is presented. Cluster adjusted χ 2 and t-tests were used to test for association with clinical and demographic factors. Results: A total of 419 DBS samples were collected from 150 PWLWH. Median TFV-DP in DBS was lowest, 552 fmol/punch [interquartile range (IQR), 395–759] in pregnancy and declined over time [914 (IQR, 644–1176) fmol/punch; early PP; 838 (IQR, 613–1063) fmol/punch 6 months PP; and 785 (IQR, 510–1009) fmol/punch 9–12 months; P < 0.001]. Only 42% of samples in pregnancy and 38.5% of samples in PP met thresholds for daily adherence. Clinical or demographic factors were not associated with suboptimal adherence levels. Conclusion: Cumulative ART exposure in PWLWH, quantified by TFV-DP in DBS, demonstrated a stepwise decrease (ie, adherence) PP. Most women demonstrated less than daily adherence throughout the peripartum period. Use of TFV-DP in DBS as a measure of cumulative ART adherence could help optimize health outcomes in PWLWH and their infants.