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Acceptability of a Combination Adherence Strategy to Support HIV Antiretroviral Therapy and Pre-exposure Prophylaxis Adherence During Pregnancy and Breastfeeding in Malawi

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Abstract

In two parallel pilot studies, we implemented a combination adherence intervention of patient-centered counselling and adherence supporter training, tailored to support HIV treatment (i.e., antiretroviral therapy) or prevention (i.e., pre-exposure prophylaxis, or PrEP) during pregnancy and breastfeeding. Using a mixed-methods approach, we evaluated the intervention’s acceptability. We investigated engagement, satisfaction, and discussion content via survey to all 151 participants assigned to the intervention arm (51 women living with HIV, 100 PrEP-eligible women without HIV). We also conducted serial in-depth interviews with a subgroup (n = 40) at enrollment, three months, and six months. In the quantitative analysis, the vast majority reported high satisfaction with intervention components and expressed desire to receive it in the future, if made available. These findings were supported in the qualitative analysis, with favorable comments about counselor engagement, intervention content and types of support received from adherence supporters. Overall, these results demonstrate high acceptability and provide support for HIV status-neutral interventions for antiretroviral adherence.

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Funding

This study was funded by the US National Institute of Allergy and Infectious Diseases (R01 AI131060). Additional investigator and administrative support is provided by NIAID (K24 AI120796, P30 AI050410), National Institute of Mental Health (K01 MH121186), and Fogarty International Center (D43 TW009340, D43 TW010060). The study funders were not involved in the study design development, writing of the protocol and in the decision to submit this article for publication.

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Authors and Affiliations

  1. University of North Carolina (UNC) Project Malawi, Bag A-104, Lilongwe, Malawi

    Friday Saidi, Twambilile Phanga, Watson Sibande, Getrude Msowoya & Annie Thom

  2. Department of Obstetrics and Gynecology, Kamuzu University of Health Sciences, Lilongwe, Malawi

    Friday Saidi

  3. Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA

    Lauren A. Graybill & Katie R. Mollan

  4. Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Lauren M. Hill & Nora E. Rosenberg

  5. Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Friday Saidi, Kellie Freeborn &  Benjamin H. Chi

  6. Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA

    K. Rivet Amico

  7. Partners in Hope, Lilongwe, Malawi

    Sam Phiri

  8. Department of Health Policy, University of Zambia School of Public Health, Lusaka, Zambia

    Wilbroad Mutale

Authors
  1. Friday Saidi
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  2. Twambilile Phanga
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  14. Benjamin H. Chi
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Contributions

BHC, WM, FS, LMH, KRM, NER were involved in study conceptualization and design. BHC, WM, KF, KRA, FS, LMH, NER developed the study intervention. LAG, FS, TP, WS, GM, LMH, BHC and WM were involved in data collection and study implementation. LMH, KRM, LAG, FS, BHC and WM contributed to data analysis and interpretation. FS and TP wrote the initial manuscript and contributed equally as first authors. All authors were involved in the review and approval of the final manuscript. All authors are accountable for all aspects of this work.

Corresponding author

Correspondence to Friday Saidi.

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Conflicts of Interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethics Approval

The study was approved by the Malawi National Health Science Research Committee (19/05/2334) and the University of North Carolina at Chapel Hill Institutional Review Board (19-1060). The study was registered at www.clinicaltrials.gov (NCT04330989).

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Written informed consent was obtained from all participants prior to data collection.

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Saidi, F., Phanga, T., Graybill, L.A. et al. Acceptability of a Combination Adherence Strategy to Support HIV Antiretroviral Therapy and Pre-exposure Prophylaxis Adherence During Pregnancy and Breastfeeding in Malawi. AIDS Behav 27, 4022–4032 (2023). https://doi.org/10.1007/s10461-023-04116-x

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