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

Ngandu, Nobubelo K.; Lombard, Carl; Mbira, Thandiwe Elsie; Puren, Adrian; Waitt, Catriona; Prendergast, Andrew J.; Tylleskär, Thorkild; Perre, Philippe Van de; Goga, Ameena

doi:10.1136/bmjopen-2021-058347

Cited by 13 publications

(20 citation statements)

References 50 publications

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“…These numbers fall short of the 95% UNAIDS target for viral suppression. In comparison, South African studies found 14.7%–14.8% postpartum viral non-suppression [34,35]. Importantly, in our study, of the 1497 ART-eligible, only 50.0% had viral load results at month 12, and 57.3% had viral load results at month 24.…”

Section: Discussioncontrasting

confidence: 72%

Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria

Young,

Chang,

Sagay

et al. 2024

Preprint

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While research involving pregnant women with HIV has largely focused on the antepartum and intrapartum periods, few studies in Nigeria have examined the clinical outcomes of these women postpartum. This study aimed to evaluate antiretroviral therapy retention, adherence, and viral suppression among postpartum women in Nigeria. This retrospective clinical data analysis included women with a delivery record at the antenatal HIV clinic at Jos University Teaching Hospital between 2013 and 2017. Descriptive statistics quantified proportions retained, adherent (≥95% medication possession ratio), and virally suppressed up to 24 months postpartum. Among 1535 included women, 1497 met the triple antiretroviral therapy eligibility criteria. At 24 months, 1342 (89.6%) women remained in care, 51 (3.4%) reported transferring, and 104 (7.0%) were lost to follow-up. The proportion of patients with ≥95% medication possession ratio decreased from 79.0% to 69.1% over the 24 months. Viral suppression among those with results was 88.7% at 24 months, but <62% of those retained had viral load results at each time point. In multiple logistic regression, predictors of loss to follow-up included having a more recent HIV diagnosis, higher gravidity, fewer antenatal care visits, and a non-hospital delivery. Predictors of viral non-suppression included poorer adherence, unsuppressed/missing baseline viral load, lower baseline CD4+ T-cell count, and higher gravidity. Loss to follow-up rates were lower and antiretroviral therapy adherence rates similar among postpartum women at our study hospital compared with other sub-Saharan countries. Longer follow-up time and inclusion of multiple facilities for a nationally representative sample would be beneficial in future studies.

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Section: Discussioncontrasting

confidence: 72%

Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria

Young,

Chang,

Sagay

et al. 2024

Preprint

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“…In contrast unsuppressed viral load decreases as number of children ever born increases in 2014 while the inverse was observed in 2015 (risk increases as number of birth increases). Recent study among pregnant women revealed significant association of currently breastfeeding with increase odd of viral load non-suppression [22,59].…”

Section: Discussionmentioning

confidence: 99%

Spatial Variation and Factors Associated with Unsuppressed HIV Viral Load among Women in An HIV Hyperendemic Area of KwaZulu-Natal, South Africa

Soogun¹,

Kharsany²,

Zewotir³

et al. 2023

Infectious Diseases

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New HIV infections among young women remains exceptionally high and to prevent onward transmission, UNAIDS set ambitious treatment targets. This study aimed to determine the prevalence, spatial variation and factors associated with unsuppressed HIV viral load at ≥400 copies per mL. This study analysed data from women aged 15–49 years from the HIV Incidence Provincial Surveillance System (HIPSS) enrolled in two sequential cross-sectional studies undertaken in 2014 and 2015 in rural and peri-urban KwaZulu-Natal, South Africa. Bayesian geoadditive model with spatial effect for a small enumeration area was adopted using Integrated Nested Laplace Approximation (INLA) function to analyze the findings. The overall prevalence of unsuppressed HIV viral load was 45.2% in 2014 and 38.1% in 2015. Factors associated with unsuppressed viral load were no prior knowledge of HIV status, had a moderate-to-low perception of acquiring HIV, not on antiretroviral therapy (ART), and having a low CD4 cell count. In 2014, women who ever consumed alcohol and in 2015, ever ran out of money, had two or more lifetime sexual partners, ever tested for tuberculosis, and ever diagnosed with sexually transmitted infection were at higher risk of being virally unsuppressed. The nonlinear effect showed that women aged 15 to 29 years, from smaller households and had fewer number of lifetime HIV tests, were more likely to be virally unsuppressed. High viral load risk areas were the north-east and south-west in 2014, with north and west in 2015. The findings provide guidance on identifying key populations and areas for targeted interventions.

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“…The collective evidence from various studies 27,31,32,34,35,47,49 revealed a statistically significant association between male gender and an increased likelihood of experiencing VNS (AOR: >1, p-value <0.05) in the context of HIV. Younger age often exhibits a higher susceptibility to experiencing VNS 10,27,30,49,50 30,34 being married or cohabitating status, 43 receiving care at smaller or medium-sized health facilities 49 or private clinics.…”

Section: Socio-demographics Factorsmentioning

confidence: 99%

Prevalence and factors associated with viral non‐suppression in people living with HIV receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review and meta‐analysis

Mosha,

Nyondo,

Munishi

et al. 2024

Reviews in Medical Virology

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Despite advances in HIV treatment, the burden of viral non‐suppression (VNS) remains a treatment success concern, particularly in Sub‐Saharan African (SSA) countries. We determined the prevalence and factors associated with VNS for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). This review, registered with PROSPERO (CRD42023470234), conducted an extensive search for evidence, focusing on PLHIV living in SSA on ART from the year 2000 to 19th October 2023, across databases including PubMed/MEDLINE, Embase, Web of Science, and Scopus. A total of 2357 articles were screened, from which 32 studies met the criteria for the final analysis, involving 756,620 PLHIV of all ages. The pooled prevalance for VNS was found to be 20.0% (95% CI: 15.43%–25.52%, I2 = 100%, p‐value <0.01) Children and adolescents demonstrated the highest prevalence of VNS (viral load ≥1000 copies/mL) at 27.98% (95% CI: 21.91%–34.97%, I2 = 94%, p‐value <0.01). The study revealed various factors associated with increased odds (risk) of VNS, p‐value <0.05. These factors encompassed socio‐demographics such as sex, age, education level, and marital status. Additionally, aspects related to HIV care, such as the facility attended, HIV status disclosure and adherence exhibited higher odds of VNS. Suboptimal ART adherence, longer duration on ART, socio‐economic factors, lack of family and social support, presence of co‐morbidities, advanced WHO HIV clinical stage, ART regimens, lower CD4+ count, abnormal body mass index, history of treatment interruptions, and progression of HIV illness were associated with VNS. Furthermore, behavioural/psychological factors including depression, substance use, negative perceptions towards ART, experiences of abuse, alcohol use, stigma, and certain patterns of sexual behaviour were also identified as factors for VNS. The occurrence of two VNS to every ten PLHIV on ART poses a threat to the progress made towards reaching the third 95% UNAIDS target in SSA. Additionally, these findings highlight the intricate interplay of various factors, encompassing patient characteristics, behavioural patterns, sociocultural influences, and pharmacological factors, all impacting VNS among PLHIV. Recognising its multifaceted nature, we recommend designing and implementing high impact interventions to effectively address VNS in SSA.

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

Cited by 13 publications

References 50 publications

Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria

Antiretroviral therapy retention, adherence, and clinical outcomes among postpartum women with HIV in Nigeria

Spatial Variation and Factors Associated with Unsuppressed HIV Viral Load among Women in An HIV Hyperendemic Area of KwaZulu-Natal, South Africa

Prevalence and factors associated with viral non‐suppression in people living with HIV receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review and meta‐analysis

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