Slow Acceptance of Universal Antiretroviral Therapy (ART) Among Mothers Enrolled in IMPAACT PROMISE Studies Across the Globe

L Stranix-Chibanda; S Brummel; J Pilotto; M Mutambanengwe; V Chanaiwa; T Mhembere; M Kamateeka; J Aizire; G Masheto; R Chamanga; M Maluwa; S Hanley; E Joao; G Theron; N Nevrekar; M Nyati; B Santos; L Aurpibul; M Mubiana-Mbewe; R Oliveira; T Anekthananon; P Mlay; K Angelidou; C Tierney; L Ziemba; A Coletti; K McCarthy; M Basar; N Chakhtoura; R Browning; J Currier; M G Fowler; P Flynn; PROMISE study team

doi:10.1007/s10461-019-02624-3

Slow Acceptance of Universal Antiretroviral Therapy (ART) Among Mothers Enrolled in IMPAACT PROMISE Studies Across the Globe

AIDS Behav. 2019 Sep;23(9):2522-2531. doi: 10.1007/s10461-019-02624-3.

Authors

L Stranix-Chibanda^{1

2}, S Brummel³, J Pilotto⁴, M Mutambanengwe⁵, V Chanaiwa⁵, T Mhembere⁵, M Kamateeka⁶, J Aizire⁶, G Masheto⁷, R Chamanga⁸, M Maluwa⁹, S Hanley¹⁰, E Joao¹¹, G Theron¹², N Nevrekar¹³, M Nyati¹⁴, B Santos¹⁵, L Aurpibul¹⁶, M Mubiana-Mbewe¹⁷, R Oliveira¹⁸, T Anekthananon¹⁹, P Mlay²⁰, K Angelidou³, C Tierney³, L Ziemba³, A Coletti²¹, K McCarthy²¹, M Basar²², N Chakhtoura²³, R Browning²⁴, J Currier²⁵, M G Fowler²⁶, P Flynn²⁷; PROMISE study team

Affiliations

¹ University of Zimbabwe College of Health Sciences, Paediatrics and Child Health, Harare, Zimbabwe. [email protected].
² University of Zimbabwe College of Health Sciences - Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe. [email protected].
³ Harvard T.H. Chan School of Public Health, Center for Biostatistics in AIDS Research in the Department of Biostatistics, Boston, USA.
⁴ Laboratorio de AIDS e Imunologia Molecular - Fiocruz, Hospital Geral de Nova Iguacu, Rio de Janeiro, Brazil.
⁵ University of Zimbabwe College of Health Sciences - Clinical Trials Research Centre, 15 Phillips Avenue, Belgravia, Harare, Zimbabwe.
⁶ Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda.
⁷ Harvard T.H. Chan School of Public Health, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
⁸ College of Medicine - Johns Hopkins Research Project, Blantyre, Malawi.
⁹ University of North Carolina Project, Lilongwe, Malawi.
¹⁰ Centre Aids Prevention Research South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
¹¹ Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
¹² Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa.
¹³ Department of Obstetrics and Gynaecology, BJ Government Medical College, Pune, India.
¹⁴ Perinatal HIV Research Unit, Johannesburg, South Africa.
¹⁵ Hospital Nossa Senhora da Conceicao, Porto Alegre, Brazil.
¹⁶ Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, China.
¹⁷ Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
¹⁸ Instituto of Pediatrics Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁹ Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
²⁰ Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
²¹ FHI 360, IMPAACT Operations Center, Durham, NC, USA.
²² Frontier Science and Technology Research Foundation, Amherst, USA.
²³ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA.
²⁴ Division of AIDS, National Institute of Allergy and Infectious Diseases, Bethesda, USA.
²⁵ Division of Infectious Diseases, University of California Los Angeles, Los Angeles, USA.
²⁶ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, USA.
²⁷ Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.

Abstract

The PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary reason given for accepting or rejecting the universal ART offer after receiving the START information. One-third of participants did not initiate ART after the initial session, wanting more time to consider. Six sessions were required to attain 95% uptake. The slow uptake of universal ART highlights the need to prepare individuals and sensitize communities regarding the personal and population benefits of the "Treat All" strategy.

Keywords: Treat All; Universal ART; Women with HIV.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Anti-HIV Agents / therapeutic use
Antiretroviral Therapy, Highly Active* / psychology
CD4 Lymphocyte Count
Female
HIV Infections / drug therapy*
HIV Infections / prevention & control
HIV Infections / transmission
Humans
Infant
Infectious Disease Transmission, Vertical / prevention & control*
Maternal Health
Mothers / psychology*
Patient Acceptance of Health Care / psychology*
Postpartum Period
Pregnancy
Pregnancy Complications, Infectious / drug therapy*
Young Adult

Substances

Anti-HIV Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding