Reduced Adherence to Antiretroviral Therapy in Pregnant Women With HIV With Intimate Partner Violence in the United States

Background: Despite increased access to antiretroviral therapy (ART) for women with HIV (WWH), poor postpartum HIV care retention persists. This analysis evaluates Intimate Partner Violence (IPV) and ART adherence in pregnant WWH. Methods: We analyzed secondary data from a US behavioral intervention trial to improve postpartum retention in WWH. Data were collected from the baseline survey including the Edinburgh Postnatal Depression Scale (EPDS), adverse childhood experiences (ACE), and HIV-related stigma scores, and the WHO Violence Against Women questionnaire to assess IPV. A multivariable logistic regression examined associations between IPV timing (before, during pregnancy, any) and type (physical, psychological, sexual) and ART adherence (≥80% ART doses in the prior month). Results: A total of 137 pregnant WWH enrolled between March 2020 and March 2024 were included: mean age was 30.5 (SD 5.6); 83% were Black, 14% Hispanic; mean number of pregnancies was 3.3 (SD 2.1). Depression, stigma, and ACEs were prevalent: EPDS scores of ≥10 were seen in 45% of women, ≥4 ACEs in 23%, and 51% reported HIV-related shame. Forty women (29%) reported IPV exposure. Higher EPDS, ACE, and stigma scores were seen in women exposed to IPV (P <.02). Physical IPV during pregnancy had the strongest association with decreased ART adherence in pregnancy (adjusted odds ratio = 0.10, P =.02). Psychological IPV and any IPV type during or before pregnancy were also associated with lower odds of adherence. Conclusions: We found high IPV rates and a significant negative association with ART adherence among pregnant WWH highlighting the importance of addressing IPV in HIV care.