Slow Acceptance of Universal Antiretroviral Therapy (ART) Among Mothers Enrolled in IMPAACT PROMISE Studies Across the Globe

AIDS Behav. 2019 Sep;23(9):2522-2531. doi: 10.1007/s10461-019-02624-3.


The PROMISE trial enrolled asymptomatic HIV-infected pregnant and postpartum women not eligible for antiretroviral treatment (ART) per local guidelines and randomly assigned proven antiretroviral strategies to assess relative efficacy for perinatal prevention plus maternal/infant safety and maternal health. The START study subsequently demonstrated clear benefit in initiating ART regardless of CD4 count. Active PROMISE participants were informed of results and women not receiving ART were strongly recommended to immediately initiate treatment to optimize their own health. We recorded their decision and the primary reason given for accepting or rejecting the universal ART offer after receiving the START information. One-third of participants did not initiate ART after the initial session, wanting more time to consider. Six sessions were required to attain 95% uptake. The slow uptake of universal ART highlights the need to prepare individuals and sensitize communities regarding the personal and population benefits of the "Treat All" strategy.

Keywords: Treat All; Universal ART; Women with HIV.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active* / psychology
  • CD4 Lymphocyte Count
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / prevention & control
  • HIV Infections / transmission
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Maternal Health
  • Mothers / psychology*
  • Patient Acceptance of Health Care / psychology*
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Young Adult


  • Anti-HIV Agents