Treatment Adherence Among Mothers Living with HIV in the US: A Scoping Review

Background and Purpose

Women living with HIV in the US struggle with adherence to life saving Antiretroviral Therapy and medical care.  The consequences of poor adherence are detrimental not only to the women, but also to their families and communities.  To improve the health outcomes of women living with HIV, social work researchers must understand how the unique circumstances of disproportionate parenting and caretaking burdens affect adherence in this population. The purpose of this research was to understand the extent to which mothers living with HIV in the US are adherent to Antiretroviral Therapy and medical care appointments.  Exploring this topic from a liberal feminist perspective allowed for the researcher to critically examine the ways that motherhood affects adherence among women living with HIV in the US. 

Methods

Using the guidelines set by Arskey and O’Malley (2005), the researcher searched five databases in the social work, public health and medical fields with predetermined search terms.  Inclusion criteria for the review were articles that involved a US population, mothers living with HIV, published between the years 2006-2016, and peer reviewed journals.  The abstracts of the resulting articles were reviewed for inclusion criteria, and the remaining articles were read and charted.  Themes were identified, and a peer review process was utilized to ensure appropriate article and theme choices. 

Results

The initial search produced 989 articles from PubMed (n=755), Public Health Database (n=141), Web of Science (n=54), Social Services Abstracts (n=21) and Social Work Abstracts (n=18).  After removal of duplicates and review for inclusion criteria, (n=35) articles were retained for the review.  Of those 35 articles, (n=17) were quantitative, (n=10) were qualitative and (n=8) were conceptual/theoretical.  The most common theme among the articles was prevention of mother to child transmission of HIV, which was addressed in (n=12) articles.  Other themes that were addressed in the articles included parenting/childcare, mental health, disease self-management, substance abuse, spirituality and social support.  The articles were not in agreement about whether the caretaking roles of the mothers was a burden or a source of strength and resiliency.

Conclusions and Implications

The overarching theme of the articles was that like women, mothers struggle with adherence to HIV treatment. Research and clinical practice in this area is focused narrowly on preventing the spread of HIV to infants during pregnancy, breastfeeding and childbirth. The consequence is that the needs of the individual mothers go unmet after the infant period has passed.  Social work and medical practitioners need to adopt a more comprehensive and longitudinal approach to care that moves beyond the temporary focus on prevention of mother to child transmission of HIV.  Mothers living with HIV need help addressing their childcare needs as well as effective mental health and substance abuse treatment when necessary.  They also require support around disease self-management practices and capitalizing on their spiritual and social strengths.  Implications for future research include explorations of the potential sources of strength and resiliency that having children may contribute to treatment adherence among these mothers.