Prevalence and risk factors of unsuppressed viral load among pregnant and breastfeeding women in sub-Saharan Africa: analysis from population-based surveys

Schrubbe, Leah; Stöckl, Heidi; Hatcher, Abigail M.; Marston, Milly; Kuchukhidze, Salome; Calvert, Clara

doi:10.1097/qad.0000000000003459

Cited by 4 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have identified younger age, shorter ART duration, and unsuppressed viral load at delivery as risk factors for unsuppressed viral load postpartum [12,37,38]. Our study similarly found unsuppressed viral load at delivery as a predictor of unsuppressed postpartum viral load; as unsuppressed viral load may indicate drug resistance, closer monitoring of these patients is needed.…”

Section: Discussionsupporting

confidence: 81%

“…This may also explain why the proportion of patients with viral suppression did not decrease over the 24 months despite declining adherence. The 2018 Nigerian HIV/AIDS Indicator and Impact Survey found 77.1% viral suppression among adults on ART, which may be closer to what we might have observed in our study if viral load results were not missing[36].Previous studies have identified younger age, shorter ART duration, and unsuppressed viral load at delivery as risk factors for unsuppressed viral load postpartum[12,37,38]. Our study similarly found unsuppressed viral load at delivery as a predictor of unsuppressed postpartum viral load; as unsuppressed viral load may indicate drug resistance, closer monitoring of these patients is needed.…”

supporting

confidence: 86%

“…Postnatal continuation of maternal ART can reduce MTCT rates to less than 2% in resource-limited countries [7][8][9]. However, ART adherence declines dramatically in mothers with HIV up to 18 months postpartum [10], and new mothers have increased risks of becoming lost to follow-up (LTFU) in HIV care and having viremia, increasing risk of transmission to infants [11,12]. Suboptimal adherence or discontinuation of ART endangers maternal health, even increasing the odds of death [13,14]; with mothers often the primary familial caregivers, poor maternal health, in turn, endangers their children's health.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Young,

Chang,

Sagay

et al. 2024

Preprint

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 81%

supporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Young,

Chang,

Sagay

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…While there is scant evidence from population-based studies examining ART adherence among women of reproductive age in sub-Saharan Africa, there are more data available specifically focusing on pregnant women [2,3]. A pooled secondary analysis of populationbased data from 2015 to 2018 from 10 sub-Saharan African countries, for example, suggests that 79.4% of pregnant and breastfeeding women living with HIV (WLH) had optimal (100%) self-reported ART adherence [3].…”

Section: Introductionmentioning

confidence: 99%

“…Women face challenges in antiretroviral therapy (ART) uptake, ART adherence and sustaining viral suppression despite remarkable progress in ART access, including for the prevention of vertical transmission of HIV [ 1 ]. While there is scant evidence from population‐based studies examining ART adherence among women of reproductive age in sub‐Saharan Africa, there are more data available specifically focusing on pregnant women [ 2 , 3 ]. A pooled secondary analysis of population‐based data from 2015 to 2018 from 10 sub‐Saharan African countries, for example, suggests that 79.4% of pregnant and breastfeeding women living with HIV (WLH) had optimal (100%) self‐reported ART adherence [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Sexual violence and antiretroviral adherence among women of reproductive age in African population‐based surveys: the moderating role of the perinatal phase

et al. 2023

Self Cite

View full text Add to dashboard Cite

Introduction Women face challenges in antiretroviral therapy (ART) adherence and achieving viral suppression despite progress in the expansion of HIV treatment. Evidence suggests that violence against women (VAW) is an important determinant of poor ART adherence in women living with HIV (WLH). In our study, we examine the association of sexual VAW and ART adherence among WLH and assess whether this association varies by whether women are pregnant/breastfeeding or not. Methods A pooled analysis was conducted among WLH from Population‐Based HIV Impact Assessment cross‐sectional surveys (2015−2018) from nine sub‐Saharan African countries. Logistic regression was used to examine the association between lifetime sexual violence and suboptimal ART adherence (≥1 missed day in the past 30 days) among reproductive age WLH on ART, and to assess whether there was any evidence for interaction by pregnancy/breastfeeding status, after adjusting for key confounders. Results A total of 5038 WLH on ART were included. Among all included women, the prevalence of sexual violence was 15.2% (95% confidence interval [CI]: 13.3%−17.1%) and the prevalence of suboptimal ART adherence was 19.8% (95% CI: 18.1%−21.5%). Among only pregnant and breastfeeding women, the prevalence of sexual violence was 13.1% (95% CI: 9.5%−16.8%) and the prevalence of suboptimal ART adherence was 20.1% (95% CI: 15.7%−24.5%). Among all included women, there was evidence for an association between sexual violence and suboptimal ART adherence (adjusted odds ratio [aOR]: 1.69, 95% CI: 1.25−2.28). There was evidence that the association between sexual violence and ART adherence varied by pregnant/breastfeeding status (p = 0.004). Pregnant and breastfeeding women with a history of sexual violence had higher odds of suboptimal ART adherence (aOR: 4.11, 95% CI: 2.13−7.92) compared to pregnant and breastfeeding women without a history of sexual violence, while among non‐pregnant and non‐breastfeeding women, this association was attenuated (aOR: 1.39, 95% CI: 1.00−1.93). Conclusions Sexual violence is associated with women's suboptimal ART adherence in sub‐Saharan Africa, with a greater effect among pregnant and breastfeeding WLH. To improve women's HIV outcomes and to achieve the elimination of vertical transmission of HIV, violence prevention efforts within maternity services and HIV care and treatment should be a policy priority.

show abstract

Trends in Prevention of Mother-to-Child Transmission of HIV at PEPFAR-Supported Sites in Mozambique, 2017–2023

Langa,

de Deus,

Arciniegas

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Mozambique has implemented Prevention of Vertical Transmission (PVT) of HIV as part of national programming since 2002. Despite gains, vertical transmission rates remain high, estimated at 9% in 2023. We describe PVT progress at PEPFAR-supported sites. Methods: We analyzed routine data from 656 PEPFAR-supported sites reported for fiscal years (October-September) 2017-2023. We calculated the proportion of pregnant women (PW) at first antenatal care (ANC1) who knew their status, HIV test positivity (positive tests divided by the total number of tests conducted); the proportion of PW on antiretroviral therapy (ART); the proportion of PW on ART with documented viral load (VL) test; the proportion of PW and breastfeeding women (BFW) with viral load suppression (VLS, defined as <1,000 copies/mL); the proportion of HIV-exposed infants (HEI) tested by 12 months who tested HIV positive; and the proportion of HEI-positives on ART. Data were analyzed by fiscal year. Results: During 2017-2023, the proportion of PW who knew their HIV status at ANC1 increased from 90.4% (863,181/954,933) to 99.9% (1,047,870/1,049,225); HIV-positivity among PW at ANC1 decreased from 9.7% (84,038/863,181) to 8.1% (84,429/1,047,870); PW on ART remained above 99%; the proportion of PW who received a VL test increased from 24.5% (9,862/40,293) to 74.9% (46,292/61,818); and VLS increased from 51.4% (5,073/9,862) to 88.5% (40,950/46,292) and 60.8% (8,643/14,205) to 92.7% (149,893/161,695) among PW and BFW, respectively. During 2017-2023, HEI testing coverage increased from 76.5% (64,322/84,038) to 96.0% (82,689/86,132), and HEI HIV positivity declined from 8.5% (5,487/64,322) to 2.5% (2,075/82,689); during 2018-2023, the proportion of HIV positive HEI on ART increased from 82.7% (3,521/4,256) to 93.3% (1,936/2,075). Conclusion: PEPFAR-supported sites have achieved progress in PVT. Continued implementation of sound interventions to improve ART initiation and retention, VLS, and HEI treatment linkage can lead to further reductions in vertical transmission and the elimination of mother-to-child transmission of HIV as a public health problem in the country.

show abstract

Prevalence and risk factors of unsuppressed viral load among pregnant and breastfeeding women in sub-Saharan Africa: analysis from population-based surveys

Cited by 4 publications

References 29 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

Sexual violence and antiretroviral adherence among women of reproductive age in African population‐based surveys: the moderating role of the perinatal phase

Trends in Prevention of Mother-to-Child Transmission of HIV at PEPFAR-Supported Sites in Mozambique, 2017–2023

Contact Info

Product

Resources

About