Compliance with antiretroviral regimens to prevent perinatal HIV-1 transmission in Kenya

Abstract

Objective: To compare compliance and infant HIV-1 infection risk at 6 weeks with theThai-CDCandHIVNET-012antiretroviralregimensinafieldsetting. Design: Randomizedclinicaltrial. Setting: TertiaryhospitalantenatalclinicinNairobi,Kenya. Participants: HIV-1infectedwomenreferredfromprimarycareclinics. Interventions: Thai-CDCzidovudineregimenorHIVNET-012nevirapineregimen. Main outcome measures: Women were considered compliant if they used>80% of thedoses.InfantsweretestedforHIV-1at6weeks. Results: Seventy women were randomized to Thai-CDC and 69 to HIVNET-012 regimens.Morewomenwerecompliantwiththeantenatal(86%)thantheintrapartum (44%) Thai-CDC regimen doses (P¼0.001). Ninety-seven per cent took the maternal and 91% gave the infant dose of the HIVNET-012 regimen (P¼0.2). Overall, 41% were compliant with the Thai-CDC regimen and 87% with the HIVNET-012 regimen (P,0.001). Compliance with the Thai-CDC regimen was associated with partner support of antiretroviral use [odds ratio (OR), 3.0;, 95% confidence interval (CI), 1.0– 9.1] and knowledge at recruitment that antiretroviral drugs could prevent infant HIV-1 (OR, 2.9; 95% CI, 1.0–8.1). Compliance with the HIVNET-012 regimen was associated with partner notification (OR, 8.0; 95% CI, 1.5–50) and partner willingness to have HIV-1 testing(OR, 7.5; 95% CI, 1.4–40). There was a trend for a higher risk of transmission with the HIVNET-012 regimen than with the Thai-CDC regimen (22% versus9%;P¼0.07). Conclusion: Compliance with the Thai-CDC and HIVNET-012 regimens was comparable to that in efficacy trials. Partner involvement, support and education on perinatal HIV-1 prevention may improve compliance and increase the number of infants protectedfromHIV-1infection.