Antiretroviral Use and Pharmacy-Based Measurement of Adherence in Postpartum HIV-Infected Women

Background.Antiretroviral treatment for HIV-infected women is standard during pregnancy to prevent vertical transmission, but data on postpartum therapy for the mother are lacking. Objective.The objective of this study was to examine the impact of provider and patient characteristics on receipt of antiretroviral therapy and pharmacy-based measurement of adherence by postpartum HIV-infected women. Research Design.This was a retrospective cohort study. Subjects.The study included 2,648 New York State Medicaid–enrolled HIV-infected women who delivered from January 1993 through October 1996 and were followed up through September 1997. Measures.From Medicaid claims in the first postpartum year, the study examined any prescribed antiretroviral therapy and, among women treated >2 months, adherence, defined as ≥80% days covered by prescribed therapy from first to last antiretroviral prescription. Results.Antiretroviral therapy was prescribed for 681 (26%) study women. Of 292 women treated >2 months, 28% were adherent on the basis of the pharmacy-based measure. The proportion of treated women was highest in 1996 (40%), and adherence was best in 1995 (44%) when most women took monotherapy. The adjusted odds ratios (AORs) of treatment were 1.67 (95% CI, 1.24 to 2.25) for women receiving HIV-focused services and 2.71 (95% CI, 1.99 to 3.69) for women with a provider in an HIV-related specialty. The AORs of adherence were greater for women with HIV-focused services (2.13; 95% CI, 1.05 to 4.30) and for former illicit drug users versus nonusers (2.40; 95% CI, 1.05 to 5.50). Conclusions.This population-based pharmacy analysis reveals improving antiretroviral use but continuing poor pharmacy-based adherence by postpartum HIV-infected women. Receipt of HIV-focused services appears to be particularly beneficial in increasing the likelihood of treatment and adherence.

[1]  R. Schooley,et al.  Antiretroviral Therapy for Adult HIV-lnfected Patients: Recommendations From a State-of-the-Art Conference , 1993 .

[2]  S. Walmsley,et al.  Participation in clinical trials among women living with HIV in Canada. Canadian Women's HIV Study Group. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[3]  L. Markson,et al.  The AIDS-defining diagnosis and subsequent complications: a survival-based severity index. , 1991, Journal of acquired immune deficiency syndromes.

[4]  A. Barthwell.  Substance use and the puzzle of adherence. , 1997, Focus.

[5]  M. Lindegren,et al.  Trends in zidovudine prescription for pregnant women infected with HIV. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[6]  A. Adimora,et al.  Perinatal HIV infection and the effect of zidovudine therapy on transmission in rural and urban counties. , 1996, JAMA.

[7]  G. Friedland,et al.  Methadone and antiretroviral medications, part II. , 1999, AIDS clinical care.

[8]  J. Fleishman,et al.  The quality of Medicaid data for HIV/AIDS research: Examination of a statewide data base , 1995 .

[9]  R. Squier.  A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. , 1990, Social science & medicine.

[10]  S. Hammer,et al.  Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the International AIDS Society-USA panel. , 1998, JAMA.

[11]  C. Manski.  Where Are We in the Evaluation of Federal Social Welfare Programs , 1990 .

[12]  Designated care programs for patients with AIDS and HIV related illnesses in designated care centers. , 1989, New York state journal of medicine.

[13]  A V Prochazka,et al.  The assessment of refill compliance using pharmacy records: methods, validity, and applications. , 1997, Journal of clinical epidemiology.

[14]  F. Altice,et al.  The Era of Adherence to HIV Therapy , 1998, Annals of Internal Medicine.

[15]  G. Friedland,et al.  Methadone and antiretroviral medications, part I. , 1999, AIDS clinical care.

[16]  Scott R. Smith,et al.  Access and use of medications in HIV disease. , 1999, Health services research.

[17]  A. Williams.  Adherence to highly active antiretroviral therapy. , 1999, The Nursing clinics of North America.

[18]  B. Yip,et al.  Barriers to use of free antiretroviral therapy in injection drug users. , 1998, JAMA.

[19]  J. Avorn,et al.  Persistence of use of lipid-lowering medications: a cross-national study. , 1998, JAMA.

[20]  D. McCaffrey,et al.  The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. , 1998, The New England journal of medicine.

[21]  Barthwell Ag.  Substance use and the puzzle of adherence. , 1997 .

[22]  F. Dabis,et al.  Rapid Change in the Use of Antiretroviral Agents and Improvement in a Population of HIV-Infected Patients: France, 1995 to 1997 , 1998 .

[23]  Success in implementing Public Health Service guidelines to reduce perinatal transmission of HIV--Louisiana, Michigan, New Jersey, and South Carolina, 1993, 1995, and 1996. , 1998, MMWR. Morbidity and mortality weekly report.

[24]  A. Perelson,et al.  HIV-1 Dynamics in Vivo: Virion Clearance Rate, Infected Cell Life-Span, and Viral Generation Time , 1996, Science.

[25]  V L Yu,et al.  Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. , 1996, AIDS care.

[26]  F. Mostashari,et al.  Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[27]  B Blackwell,et al.  Drug therapy: patient compliance. , 1973, The New England journal of medicine.

[28]  L. Kalish,et al.  After AIDS clinical trial 076: the changing pattern of zidovudine use during pregnancy, and the subsequent reduction in the vertical transmission of human immunodeficiency virus in a cohort of infected women and their infants. Women and Infants Transmission Study Group. , 1996, The Journal of infectious diseases.

[29]  L. Markson,et al.  Health Care Delivery, Zidovudine Use, and Survival of Women and Men with AIDS , 1994, Journal of acquired immune deficiency syndromes.

[30]  Douglas D. Richman,et al.  Antiretroviral therapy for HIV infection in 1996 : Recommendations of an international panel , 1996 .

[31]  A. Tseng.  Compliance issues in the treatment of HIV infection. , 1998, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[32]  D. Katzenstein,et al.  Characterizing patterns of drug‐taking behavior with a multiple drug regimen in an AIDS clinical trial , 1998, AIDS.

[33]  A. Wu,et al.  Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[34]  W. Hauck,et al.  Adherence to Antiretroviral Therapy by Pregnant Women Infected With Human Immunodeficiency Virus: A Pharmacy Claims‐Based Analysis , 2000, Obstetrics and gynecology.

[35]  L. Markson,et al.  Estimation of survival after AIDS diagnosis: CD4 T lymphocyte count versus clinical severity. , 1996, Journal of clinical epidemiology.

[36]  D. Sclar,et al.  Effect of health education in promoting prescription refill compliance among patients with hypertension. , 1991, Clinical therapeutics.

[37]  W. Hauck,et al.  Translating Clinical Trial Results into Practice: The Effect of an AIDS Clinical Trial on Prescribed Antiretroviral Therapy for HIV-Infected Pregnant Women , 1999, Annals of Internal Medicine.

[38]  W. Hauck,et al.  Cigarette smoking and maternal-child HIV transmission. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[39]  E. Morse,et al.  Determinants of subject compliance within an experimental anti-HIV drug protocol. , 1991, Social science & medicine.

[40]  P. Jatlow,et al.  Methadone effects on zidovudine disposition (AIDS Clinical Trials Group 262). , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[41]  W. Katon,et al.  The Role of the Primary Care Physician in Patients' Adherence to Antidepressant Therapy , 1995, Medical care.

[42]  J. LoGerfo,et al.  Assessing compliance to antihypertensive medications using computer-based pharmacy records. , 1997, Medical care.

[43]  M. Fletcher,et al.  Disease progression, adherence, and response to protease inhibitor therapy for HIV infection in an Urban Veterans Affairs Medical Center. , 1999, Journal of acquired immune deficiency syndromes.