BACKGROUND. Antiretroviral treatment for HIV-infected women is standard dur
ing pregnancy to prevent vertical transmission, but data on postpartum ther
apy for the mother are lacking.
OBJECTIVE. The objective of this study was to examine the impact of provide
r and patient characteristics on receipt of antiretroviral therapy and phar
macy-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-inf
ected women who delivered from January 1993 through October 1996 and were f
ollowed up through September 1997.
MEASURES. From Medicaid claims in the first postpartum year, the study exam
ined any prescribed antiretroviral therapy and, among women treated >2 mont
hs, adherence, defined as greater than or equal to 80% days covered by pres
cribed therapy from first to last antiretroviral prescription.
RESULTS. Antiretroviral therapy was prescribed for 681 (26%) study women. O
f 292 women treated >2 months, 28% were adherent on the basis of the pharma
cy-based measure. The proportion of treated women was highest in 1996 (40%)
, and adherence was best in 1995 (44%) when most women took monotherapy. Th
e 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) f
or 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 t
o 5.50).
CONCLUSIONS. This population-based pharmacy analysis reveals improving anti
retroviral use but continuing poor pharmacy-based adherence by postpartum H
IV-infected women. Receipt of HIV-focused services appears to be particular
ly beneficial in increasing the likelihood of treatment and adherence.