Although rare, perinatal HIV transmission still occurs in the United States and most transmissions are preventable. We aim to identify patient barriers to antiretroviral therapy (ART) adherence during pregnancy and assess patient understanding of maternal-to-child transmission (MTCT).METHODS:
This cross-sectional survey recruited HIV positive postpartum women at Grady Memorial Hospital in Atlanta between January 2016 and July 2017. Survey questions included demographic characteristics, HIV history, knowledge of MTCT and ART adherence. Perinatal and HIV outcomes were assessed using chart abstraction. Results are descriptive.RESULTS:
Of 52 HIV positive women during the study period, 32 were eligible and consented to participation. Participating women were aged 18 to 40 years, 97% were African American, and 68% had ≥3 pregnancies. Five women had acquired HIV congenitally. Seven women (22%) had a detectable viral load at the time of delivery and three of these reported taking ART few days per week. Eleven women received intrapartum AZT. There were no cases of perinatal HIV. Only 75% of participants reported daily ART adherence and the most frequent reason for missing pills was forgetting (61%). Approximately 1/4 of women either did not know or believed a vaginal delivery, regardless of viral load, would increase their risk of MTCT.CONCLUSION:
One quarter of women were not compliant with daily ART during pregnancy. Detectable viral load at delivery is the greatest risk factor for transmission, therefore strategies to address ART adherence are needed. Additionally, persistent misunderstanding exists regarding risk of vaginal delivery with maternal HIV.