Factors Associated With Peripartum Virologic Suppression in Eastern Cape Province, South Africa: A Retrospective Cross-Sectional Analysis. (2nd March 2021)

• Record Type: Journal Article
• Authors: Adeniyi, Oladele Vincent; Obi, Chikwelu Larry; Goon, Daniel Ter; Iweriebor, Benson; Selanto-Chairman, Nonkosi; Carty, Craig; Avramovic, Gordana; Ajayi, Anthony Idowu; Lambert, John; Okoh, Anthony
• Is Part Of: Clinical infectious diseases. Volume 73:Number 10(2021)
• Page Start: 1750
• Page End: 1758
• Publication Date: 2021-03-02
• Subjects: antiretroviral therapy -- HIV -- in utero transmission -- mother-to-child transmission -- South Africa; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab206
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: This study describes the characteristics of pregnant women on antiretroviral therapy (ART) and the rate of peripartum virologic suppression in a large prevention of mother-to-child transmission cohort who delivered in some selected maternity centers in Eastern Cape Province, South Africa. In addition, the study examines the factors associated with virologic suppression in the cohort. Methods: This multicenter, retrospective cross-sectional analysis included medical data of 1709 women with human immunodeficiency virus between September 2015 and May 2016 in Eastern Cape Province. The main outcome measure was the rate of peripartum virologic suppression, defined as viral load (VL) <1000 copies/mL and undetectable viremia (VL <20 copies/mL). Correlates of peripartum virologic suppression and undetectable viremia were examined by fitting logistic regression model analysis. Results: Of 1463 women with available VL results, the overall rate of peripartum suppression was 82%, and undetectable viremia was 56.9%. Being aged 24 years or younger (adjusted odds ratio [AOR], 0.68 [95% confidence interval {CI}, .48–.94]), smoking during pregnancy (AOR, 0.50 [95% CI, .28–.90]), and starting ART in the first trimester were associated with lower odds of viral suppression (<1000 copies/mL). Women who had never defaulted ART had an increased odds of having an undetectable VL (AOR, 3.09 [95% CI, 2.12–4.49]) and virologic suppression (AOR, 3.88 [95% CI, 2.62–5.74]) compared to those who defaulted. Conclusions: More than half of the women achieved undetectable VL, and 4 in 5 women achieved viral suppression at delivery in the region. Early antenatal booking, combined with enhanced adherence support for pregnant women on ART, would be crucial toward achieving the goal of elimination of mother-to-child transmission in the region. Abstract : In this multicenter, cross-sectional analysis of women with human immunodeficiency virus, younger age (18–24 years) and smoking during pregnancy were significantly associated with lower odds of peripartum virologic suppression. Self-reported complete adherence was associated with higher odds of peripartum viral load suppression.