Background
Adherence to anti-retroviral therapy (ART) is essential for HIV management, and self-efficacy (i.e., one’s confidence in adhering to their medication regimen) correlates to adherence and viral load (VL) suppression. We developed ASES-Chichewa, a 10-item adherence self-efficacy scale (ASES) for Malawi, where lifelong ART is provided to pregnant/breastfeeding women living with HIV to reduce vertical transmission; ASES-Chichewa was created through formal translation and adaptation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). We aimed to evaluate ASES-Chichewa’s ability to estimate ART adherence and VL suppression for its target population.
Methods
ASES-Chichewa measured the antenatal ASES of 1470 pregnant women living with HIV at Bwaila Hospital in Lilongwe, Malawi from 2015-19, 399 of which were enrolled and followed for 3 years (NCT02249962). The proportion of participants achieving VL suppression by 6-month follow-up was compared between perfect (100%) and imperfect (<100%) self-efficacy survey scores using chi-square tests.
Results
VL suppression did not differ between ASES-Chichewa self-efficacy groups. 79% and 81% of participants with ASES-Chichewa perfect and imperfect self-efficacy, respectively, achieved VL suppression by 6-month follow-up (p = 0.6). Principal components analysis identified one item of ASES-Chichewa as a major contributor to ASES variance; this item, ASES-Chichewa-1, asked participants: “How confident are you that you can continue with your treatment (ART) even when your daily routine is disrupted?” When using ASES-Chichewa-1 to define perfect and imperfect self-efficacy, significant differences in VL suppression were found between self-efficacy groups. 82% and 52% of participants with ASES-Chichewa-1 perfect and imperfect self-efficacy, respectively, achieved VL suppression by 6-month follow-up (p = 0.02).
Conclusions
After reducing ASES-Chichewa from a 10-item questionnaire to single-item self-efficacy screener (ASES-Chichewa-1), there were significant associations between self-efficacy and VL suppression at 6 months for pregnant women living with HIV. Further study on prospective screening with ASES-Chichewa-1 is warranted to identify Malawian women at risk for not achieving VL suppression prior to delivery. Interventions to improve ART self-efficacy and adherence are critical to achieve VL suppression and prevent vertical transmission.
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