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Viral suppression and factors associated with failure to achieve viral suppression among pregnant women in South Africa: a national cross-sectional survey.
AIDS 2019 December 10
OBJECTIVE: To describe viral load (VL) levels among pregnant women and factors associated with failure to achieve viral suppression (VL≤50 copies/mL) (VS) during pregnancy.
DESIGN: Between 1 October and 15 November 2017, a cross-sectional survey was conducted among 15-49 year old pregnant women attending antenatal care (ANC) in 1,595 nationally representative public facilities.
METHODS: Blood specimens were taken from each pregnant woman and tested for HIV. VL testing was done on all HIV-positive specimens. Demographic and clinical data were extracted from medical records or self-reported. Survey logistic regression examined factors associated with failure to achieve VS.
RESULT: Of 10,052 HIV-positive participants with VL data, 56.2% were virally suppressed. Participants initiating ART prior to pregnancy had higher VS (71.0%) by their third trimester compared with participants initiating ART during pregnancy (59.3%). Booking for ANC during the third trimester vs earlier: (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI):1.4-2.3), low frequency of ANC visits (AOR for 2 ANC visits vs ≥4 ANC visits: 2.0, 95%CI:1.7-2.4), delayed initiation of ART (AOR for ART initiated at the second trimester vs before pregnancy:2.2, 95%CI:1.8-2.7), and younger age (AOR for 15-24years vs 35-49years: 1.4, 95%CI:1.2-1.8) were associated with failure to achieve VS at third trimester.
CONCLUSION: Failure to achieve VS was primarily associated with late initiation of ANC and late initiation of ART. Efforts to improve early ANC booking and early ART initiation in the general population would help improve VS rates among pregnant women. In addition, the study found, despite initiating ART prior to pregnancy, more than one quarter of participants did not achieve VS in their third trimester. This highlights the need to closely monitor VL and strengthen counselling and support services for ART adherence.
DESIGN: Between 1 October and 15 November 2017, a cross-sectional survey was conducted among 15-49 year old pregnant women attending antenatal care (ANC) in 1,595 nationally representative public facilities.
METHODS: Blood specimens were taken from each pregnant woman and tested for HIV. VL testing was done on all HIV-positive specimens. Demographic and clinical data were extracted from medical records or self-reported. Survey logistic regression examined factors associated with failure to achieve VS.
RESULT: Of 10,052 HIV-positive participants with VL data, 56.2% were virally suppressed. Participants initiating ART prior to pregnancy had higher VS (71.0%) by their third trimester compared with participants initiating ART during pregnancy (59.3%). Booking for ANC during the third trimester vs earlier: (adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI):1.4-2.3), low frequency of ANC visits (AOR for 2 ANC visits vs ≥4 ANC visits: 2.0, 95%CI:1.7-2.4), delayed initiation of ART (AOR for ART initiated at the second trimester vs before pregnancy:2.2, 95%CI:1.8-2.7), and younger age (AOR for 15-24years vs 35-49years: 1.4, 95%CI:1.2-1.8) were associated with failure to achieve VS at third trimester.
CONCLUSION: Failure to achieve VS was primarily associated with late initiation of ANC and late initiation of ART. Efforts to improve early ANC booking and early ART initiation in the general population would help improve VS rates among pregnant women. In addition, the study found, despite initiating ART prior to pregnancy, more than one quarter of participants did not achieve VS in their third trimester. This highlights the need to closely monitor VL and strengthen counselling and support services for ART adherence.
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