Adherence to antiretroviral therapy by pregnant women infected with human immunodeficiency virus: A pharmacy claims-based analysis

Objective: To assess adherence to antiretroviral therapy with the use of Me dicaid pharmacy claims data for human immunodeficiency virus (HIV)-infected pregnant women and to identify associated maternal and health care factors . Methods: We retrospectively studied a cohort of 2714 HIV-infected women in New York State who delivered live infants from 1993-96; Among 682 women pre scribed antiretroviral therapy in the last two trimesters, we studied 549 w ho started therapy more than 2 months before delivery. Adherence was define d as adequate if the supplied drug covered at least 80% of the days from th e first prescription in the last two trimesters until delivery. Multivariab le analyses were used to examine associations between maternal and health c are factors and adherence. Results: Only 34.2% of 549 subjects had at least 80% adherence based on pha rmacy data, a rate that remained stable over time. The adjusted odds ratios (ORs) of adherence for black (OR 0.47, 95% confidence interval [CI] 0.30, 0.75) and Hispanic (OR 0.49, 95% CI 0.29, 0.82) women were nearly 50% lower than for white women. The OR of adherence was 0.32 (95% CI 0.12, 0.90) for teenagers compared with women aged 25-29 years and 0.56 (95% CI 0.34, 0.92 ) for women in New York City versus those residing elsewhere. Women on anti retroviral therapy before pregnancy were more likely to adhere (OR 1.55, 95 % CI 1.02, 2.35). Conclusion: Teenagers, women of minority groups, and women living in New Yo rk City had greater risks of poor antiretroviral adherence, whereas women a lready prescribed antiretrovirals before pregnancy had better adherence. Ou r conservative pharmacy data-based measure showed that most HIV -infected w omen adhered poorly and adherence did not improve over the 4-year study. (C ) 2000 by The American College of Obstetricians and Gynecologists.