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

• Published in: BMJ open Vol. 12; no. 3; p. e058347
• Main Authors: Ngandu, Nobubelo Kwanele, Lombard, Carl J, Mbira, Thandiwe Elsie, Puren, Adrian, Waitt, Catriona, Prendergast, Andrew J, Tylleskär, Thorkild, Van de Perre, Philippe, Goga, Ameena Ebrahim
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 10-03-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; Birth weight; Body mass index; Breastfeeding & lactation; Childrens health; community child health; Cross-Sectional Studies; Data collection; Disease prevention; Disease transmission; Drug dosages; Drug resistance; Epidemiology; Family income; Female; Gynecology and obstetrics; HIV; HIV & AIDS; HIV Infections - drug therapy; HIV Infections - epidemiology; Human health and pathology; Human immunodeficiency virus; Humans; Infant; Infectious diseases; Laboratories; Life Sciences; Mothers; Postpartum Period; Pregnancy; Santé publique et épidémiologie; South Africa - epidemiology; Variables; Viral Load; Viremia - drug therapy; Womens health; South Africa; epidemiology; HIV & AIDS; community child health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-058347

ObjectivesWe 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.DesignCross-sectional study.SettingThe eight largest community health centres of Ehlanzeni, a rural district in northeast South Africa.ParticipantsPregnant 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.Primary outcome measuresThe 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, χ2 tests and multivariable logistic regression analysis were conducted.ResultsAll 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.ConclusionsThe 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.