Abstract
We determined social and behavioral factors associated with virologic non-suppression among pregnant women receiving Option B+ antiretroviral treatment (ART). Baseline data was used from women in Mobile WAChX trial from 6 public maternal child health (MCH) clinics in Kenya. Virologic non-suppression was defined as HIV viral load (VL) ≥1000 copies/ml. Antiretroviral resistance testing was performed using oligonucleotide ligation (OLA) assay. ART adherence information, motivation and behavioral skills were assessed using Lifewindows IMB tool, depression using PHQ-9, and food insecurity with the Household Food Insecurity Access Scale. Correlates of virologic non-suppression were assessed using Poisson regression. Among 470 pregnant women on ART ≥4 months, 57 (12.1%) had virologic non-suppression, of whom 65% had HIV drug resistance mutations. In univariate analyses, risk of virologic non-suppression was associated with moderate-to-severe food insecurity (RR 1.80 [95% CI 1.06–3.05]), and varied significantly by clinic site (range 2%-22%, p <0.001). In contrast, disclosure (RR 0.36 [95% CI 0.17–0.78]) and having higher adherence skills (RR 0.70 [95% CI 0.58–0.85]) were associated with lower risk of virologic non-suppression. In multivariate analysis adjusting for clinic site, disclosure, depression symptoms, adherence behavior skills and food insecurity, disclosure and food insecurity remained associated with virologic non-suppression. Age, side-effects, social support, physical or emotional abuse, and distance were not associated with virologic non-suppression. Prevalence of virologic non-suppression among pregnant women on ART was appreciable and associated with food insecurity, disclosure and frequent drug resistance. HIV VL and resistance monitoring, and tailored counseling addressing food security and disclosure, may improve virologic suppression in pregnancy.
Highlights
Prevention of mother-to-child HIV transmission (PMTCT) programs currently reach >90% of pregnant women in regions of sub-Saharan Africa (SSA) [1]
Prevalence of drug resistance among pregnant or postpartum women living with HIV (WLWH) in SSA has ranged from 6% to 46% [4,5,6,7]
Among 824 participants, 470 women had been on antiretroviral treatment (ART) for 4 months at enrollment and were included in analyses
Summary
Prevention of mother-to-child HIV transmission (PMTCT) programs currently reach >90% of pregnant women in regions of sub-Saharan Africa (SSA) [1]. While high antiretroviral treatment (ART) coverage is encouraging, poor ART adherence in pregnancy and postpartum remains a challenge. Poor ART adherence in pregnancy can lead to viral non-suppression and HIV drug resistance, increasing risk of maternal treatment failure and MTCT [2, 3]. Prevalence of drug resistance among pregnant or postpartum women living with HIV (WLWH) in SSA has ranged from 6% to 46% [4,5,6,7]. Adherence to ART may falter during pregnancy or postpartum due to varied factors, including stigma, non-disclosure, partner violence, and side-effects [2, 8,9,10,11,12]. It is important to understand women’s motivation, knowledge, and behavioral skills to sustain ART adherence in pregnancy
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