Non-adherence to antiretroviral therapy in pregnant women with HIV in Brazil, 2014–2019: a spatial analysis

This ecological study analyzed spatial patterns of non-adherence to antiretroviral therapy (ART) among pregnant women initiating treatment in Brazil from 2014 to 2019. Data were obtained from national systems: SICLOM, SISCEL, and IBGE. Among 23,757 pregnant women aged 15-49, most were aged 20-29 (54%), identified as brown (37.7%), had 8-11 years of education (7.9%), and lacked a partner (36.7%). The non-adherence rate was 20% (n = 4,742). Higher non-adherence was associated with being aged 20-24 (29%, p < 0.005), brown skin color (39.8%, p < 0.005), low education (0-7 years, 27.2%, p < 0.005), no partner (38%, p < 0.005), and changes in ART regimens (19.9%, p < 0.005). Spatial analysis showed higher non-adherence rates in the North and Northeast and lower rates in the South and Central-West. These findings reveal that social vulnerabilities, particularly in less developed regions, hinder ART adherence. Strengthening social policies and improving health service distribution are crucial to ensuring equitable access and supporting pregnant women living with HIV, especially in rural and remote areas.