Stress, Distress and ARV Adherence in HIV-Infected Mothers.
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Significance In California, the majority of women with HIV infection are in their childbearing years. HIV-infected women who become pregnant have the option to receive highly active antiretroviral therapy (HAART) both to reduce perinatal HIV transmission as well as to delay maternal disease progression. It has been documented that the use of HAART significantly reduces the risk of perinatal transmission from 25% to less than 2%. As a result, the vast majority of HIV-infected pregnant women are expected to give birth to uninfected, healthy infants. However, the HIV status of these infants is not immediately known, and requires several HIV-specific viral laboratory tests during the first few months of life to determine their infection status. Ninety-nine percent of infected infants are diagnosed during the first four months of life so negative HIV viral test results during this time can be reassuring to parents. However, maternal perceptions of uncertainty about an infant’s HIV infection status during the testing period can contribute to psychological distress and physiological stress. Perceptions of stress and distress in HIV-infected individuals have been associated with erratic adherence to antiretroviral medications, alterations in immune function, and increased mortality rates. In addition, inconsistent maternal adherence to HIV medications has been linked to sub-optimal administration of HIV prophylactic medications to perinatally exposed infants, thereby increasing the risk of infection in these infants. This study has been designed to investigate aspects of maternal stress, distress, coping, and medication adherence that have not been addressed previously in HIV-infected childbearing women. Information gained from this study will provide clinicians with knowledge to improve the clinical care of HIV-infected mothers and provide a foundation for developing interventions that may improve maternal and infant health outcomes during this potentially stressful period. Study Objectives and Aims The primary objective of the study is to describe perceptions of maternal uncertainty, stress, and distress in HIV-infected women in association with the unknown HIV status of their infants, and document changes in these variables over time. Secondary objectives include determining relationships between maternal social support and perceptions of stress and distress; and between levels of maternal stress and distress and adherence to antiretroviral medications in the mothers and their infants. Study Design This is a prospective, longitudinal study of HIV-infected mothers and their infants designed to determine the effects of unknown infant HIV status on: 1) maternal perceptions of uncertainty; 2) maternal perceptions of stress; 3) maternal perceptions of psychological distress; 4) perceived maternal social support; and 5) adherence to maternal and infant HIV drug regimens. Study variables are measured in women at six time points (once during the third trimester of pregnancy and five times after delivery). Subjects must be English-speaking; at least 18 years old; pregnant at the time of consent; and subsequently giving birth to a healthy infant. Data are collected using standardized questionnaires and open-ended questions. Maternal and infant medical records are abstracted to confirm their health status. Data analyses will consist of statistical methods for quantitative responses and content analysis for qualitative responses.