Predictors of viral suppression in HIV-infected pregnant and breastfeeding women with unsuppressed initial viral load in Central Uganda

Abstract

The major objective of this study is to establish predictors to viral suppression for HIV-infected pregnant and breastfeeding women on ART with unsuppressed initial viral load in central Uganda. Data on HIV-infected pregnant and breastfeeding women from central Uganda on ART who had an unsuppressed initial viral load between January 2015 and August 2016 were extracted from the National Viral Load database housed at Uganda National Health Laboratories Systems (UNHLS). A total of 238 women were included in the analysis. Analysis was based on fitting a Generalised Linear Model with a logistic link to generate odds ratios, their standard errors and corresponding p-values to establish patient level and health system factors that contribute to attainment of women’s viral load suppression at repeat test. The proportion of HIV-infected pregnant and breastfeeding women on ART with unsuppressed initial viral load that attain viral suppression at the repeat test in central Uganda was estimated at 58.2%. The odds for a suppressed repeat viral load increase for women with baseline CD4 of 500 or more cell counts (OR=3.557, P-value < 0.05) and women with advanced baseline WHO stage (Stage III or IV) (OR=3.209, P-value < 0.05). On the other hand, results of this study showed that odds for a suppressed repeat viral load reduce for women who had a Niverapine based baseline ART regimen in comparison to those with Effervirence based baseline ART regimen (OR=0.325, P-value < 0.05). It is therefore recommended that the government should ensure that all health facilities providing antenatal care services are stocked with HIV test kits to facilitate mandatory HIV testing early in pregnancy. This will be key in identifying HIV positive pregnant women when their immunity is still high, that is CD4 cell count above 500 cells. Additionally, the government should improve access to timely CD4 testing such that every newly identified HIV positive pregnant and breastfeeding woman gets a baseline CD4 test at ART initiation. HIV positive pregnant and breastfeeding women should be initiated on more efficacious Effervirence based regimens, as opposed Nevirapine based regimens. HIV positive pregnant and breastfeeding women initiated on Nevirapine based regimens should be transitioned to Effervirence based regimens.