HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa: a cross-sectional survey.



Ngandu, Nobubelo Kwanele, Lombard, Carl J, Mbira, Thandiwe Elsie, Puren, Adrian, Waitt, Catriona ORCID: 0000-0003-0134-5855, Prendergast, Andrew J, Tylleskär, Thorkild, Van de Perre, Philippe and Goga, Ameena Ebrahim
(2022) HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa: a cross-sectional survey. BMJ open, 12 (3). e058347-e058347.

[img] Text
HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa.pdf - Published version

Download (340kB) | Preview

Abstract

<h4>Objectives</h4>We aimed to measure the prevalence of maternal HIV viral load (VL) non-suppression and assess associated factors, to evaluate progress towards United Nations-AIDS (UNAIDS) targets.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>The eight largest community health centres of Ehlanzeni, a rural district in northeast South Africa.<h4>Participants</h4>Pregnant women living with HIV (WLHIV) in their third trimester and postpartum WLHIV and their biological infants, recruited equally across all stages of the first 24 months post partum, were included. A sample of 612 mothers participated from a target of 1000.<h4>Primary outcome measures</h4>The primary outcome was maternal VL (mVL) non-suppression (defined here as mVL >1000 copies/mL). We collected information on antiretroviral use, healthcare visits and sociodemographics through interviews and measured plasma mVL. Descriptive statistics, χ<sup>2</sup> tests and multivariable logistic regression analysis were conducted.<h4>Results</h4>All mothers (median age: 30 years) were on antiretroviral therapy (ART) and 24.9% were on ART ≤12 months. The prevalence of mVL non-suppression was 14.7% (95% CI: 11.3% to 19.0%), while 13.8% had low-level viraemia (50-1000 copies/mL). Most (68.9%) women had initiated breast feeding and 37.6% were currently breast feeding their infants. Being younger than 25 years (adjusted odds ratio (AOR): 2.6 (95% CI: 1.1 to 6.4)), on first-line ART (AOR: 2.3 (95% CI: 1.1 to 4.6)) and married/cohabiting (AOR: 1.9 (95% CI: 1.0 to 3.7)) were significantly associated with increased odds of mVL non-suppression.<h4>Conclusions</h4>The prevalence of mVL ≤1000 copies/mL of 85.3% among pregnant and postpartum WLHIV and attending public healthcare centres in this rural district is below the 2020 90-90-90 and 2030 95-95-95 UNAIDS targets. Given that low-level viraemia may also increase the risk of vertical HIV transmission, we recommend strengthened implementation of the new guidelines which include better ART options, improved ART regimen switching and mVL monitoring schedules, and intensified psychosocial support for younger women, while exploring district-level complementary interventions, to sustain VLs below 50 copies/mL among all women.

Item Type: Article
Uncontrolled Keywords: HIV & AIDS, community child health, epidemiology
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 13 Jun 2022 08:26
Last Modified: 19 Oct 2023 04:02
DOI: 10.1136/bmjopen-2021-058347
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3156267