Psychological processes involved in adherence to art and prenatal care utilization among HIV infected, pregnant women

Rates of HIV infection in the United States remain high, and many HIV infected women experience pregnancy. Advances in treatments, namely antiretroviral therapy (ART), have allowed persons to live with HIV as a chronic illness. However, high levels of adherence are required in order to achieve optimal benefit from treatment. These advances in treatment, have allowed vertical transmission of HIV to be virtually eradicated. Without prenatal care, interventions geared at reducing vertical transmission cannot be implemented, nor can health of the mother be optimized. Understanding which factors predict adherence to ART as well as prenatal care utilization is vital to our understanding of what constitutes the best treatment of this group.According to the World Health Organization, a comprehensive model explaining all aspects of adherence does not yet exist. However, five dimensions have been proposed: social and economic factors, therapy-related factors, patient-related factors, condition-related factors, and health system factors. The current study is concerned with patient-related factors, as well as their interaction with health system factors. The current study sought to evaluate whether differences exist in cognitive appraisal of HIV, health beliefs, satisfaction with the patient-provider relationship, depression, and adjustment among women who missed doses of ART or initiated prenatal care late versus women who did not. Participants (N=10) were recruited from a high-risk obstetrics clinic in Philadelphia, PA. Adherence to ART was assessed using both pharmacy refill data and self-report while prenatal care utilization was assessed using the Kotelchuck Adequacy of Prenatal Care Utilization Index.The current study found high levels of adherence to ART, early initiation of prenatal care, and a high number of completed prenatal care visits among the sample. The current study also found differences in cognitive appraisal of HIV and adjustment among participants who missed at least one dose of medication in the past two weeks versus those who did not. However, the current study did not detect differences in adjustment and cognitive appraisal of HIV among women who initiated prenatal care late versus those women who initiated prenatal care earlier in pregnancy. Given the small sample size, results should be interpreted with caution.Ph.D., Clinical Psychology -- Drexel University, 200