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Title
Barriers to ART adherence in neonates and infants from the LIFE study in Mozambique
Presenter
Kassia Pereira
Authors
K. Pereira1, A. Mahumane1, W.C. Buck2, M. Müller3, A. Patrício4, S. Bocharnikov4, J. Lequechane1, M. Maviga1, J. Ndarissone1, F. Chale1, K. Elsbernd3,5, B. Meggi1, A. Kroidl3,6, I. Jani1, LIFE Study Group
Institutions
1Instituto Nacional de Saúde, Maputo, Mozambique, 2University of California Los Angeles David Geffen School of Medicine, Los Angeles, United States, 3Division of Infectious Diseases and Tropical Medicine, University of Munich (LMU), Munich, Germany, 4Clinton Health Access Initiative, Maputo, Mozambique, 5Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, University of Munich (LMU), Munich, Germany, 6German Center for Infection Research (DZIF), partner site Munich, Munich, Germany

BACKGROUND: In 2021, only 65% of Mozambican children on antiretroviral therapy (ART) were virologically suppressed. Poor adherence is the principal driver of ART failure, and a deeper understanding of underlying causes is needed for improved treatment support, particularly for infants who have even lower suppression rates. Data from intensified adherence support visits for HIV-positive neonates and infants enrolled in the LIFE study in Mozambique were analyzed to address this knowledge gap.
METHODS: Infants with positive point-of-care virologic tests at birth or post-natal visits initiated ART and were followed up to 18 months of age, with routine viral load monitoring. Information from adherence interventions was extracted from narrative reports and merged with clinical data.
RESULTS: A total of 117 recruited infants tested HIV-positive. DTG-based ART was initiated in 2 (1.7%) infants and 39 (33.3%) transitioned from LPVr to DTG-based ART. At 6, 12, and 18-month study visits, 70.3%, 72.7%, and 63.6% of caregivers reported no ART interruptions in the past week. Virologic suppression rates for the same study visits were 31.1%, 47.0%, and 50.9%. Qualitative adherence data was available for 62.4% (73/117) of participants. The percentage of infants with reported barriers by category were: 1) paternal-related, 72.6% (53/73); 2) maternal-related, 60.3% (44/73); 3) socioeconomic, 42.5% (31/73); 4) medication-related, 32.9% (24/73); and 5) provider-related, 5.5% (4/73). Non-disclosure to the father was a noted adherence barrier for 28.8% (21/73). Excluding infants with missing data, 33.7% (28/83) of mothers had not disclosed their serostatus to the father by the first adherence intervention, and 75.0% (21/28) of them lived with the father. Fear of abandonment was the most common reason for non-disclosure to fathers, reported for 67.9% (19/28) of mothers.
CONCLUSIONS: Medication-related adherence barriers were common, and most children received LPVr-based ART. It was not possible to quantify in this analysis, but the recent introduction of dispersible DTG tablets, allowing for once-daily dosing, has the potential to improve the unacceptably low virologic suppression rates observed. However, the impact of optimized pediatric ART will be minimized without intensified and proactive efforts to identify and address family-specific barriers that adversely impact adherence, with particular attention to paternal factors and serostatus disclosure.

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