Adherence to Antiretroviral Treatment Decreases During Postpartum Compared to Pregnancy: A Longitudinal Electronic Monitoring Study

As recently published in your Journal, the LILAC prospective cohort study showed a decrease in self-reported adherence between pregnancy and postpartum in South America. 1 Interestingly, our smaller study with a longitudinal measure and analysis of adherence to antiretroviral treatment confirms these findings.Antiretroviral therapy (ART) during pregnancy and postpartum involves two issues: prophylaxis of perinatal transmission and treatment of maternal infection. 2Adherence, defined as ''the process by which patients take their medications as prescribed,'' is crucial to address these concerns. 3,4regnancy and the first months of motherhood cause important changes in a women's life, which might impact ART adherence.Most frequently cited barriers to adherence were competition with other issues including family obligation and hectic lifestyle.Conversely, the baby's health was cited as a motivator for adherence. 5][9][10] Most of published studies are based on pill count or self-reported adherence.To our knowledge this is the first study assessing electronically the dynamics of adherence in a continuum from pregnancy to postpartum along with clinical data.This exploratory, retrospective study was approved by the Swiss Ethic Commission (Vaud) for clinical research.It aimed at comparing adherence to the entire ART-during pregnancy and postpartum-using continuous electronic drug monitoring data.The community Pharmacy of the Department of ambulatory care and community medicine in Lausanne has been running an adherence-enhancing program since 2004, which combines electronic drug monitoring and semistructured, repeated motivational interviews. 4All pregnant HIV-positive women having taken part in the program between 2004 and 2012 were retrieved.