| dc.description.abstract | Abstract
Background: Uganda’s decrease in mother-to-child transmission of HIV (MTCT) has
stagnated, making it almost impossible to achieve the target of zero new HIV infections.
Objectives: The aim of this study has been to determine, among a group of HIV infected
women enrolled on universal antiretroviral treatment in Lira, Northern Uganda, the
prevalence and factors associated with: a) unintended pregnancy, b) detectable viral load, c)
infant nevirapine prophylaxis, and d) exclusive breastfeeding.
Methods: A survey of 518 HIV infected pregnant women in 2018 was to determine the
prevalence and predictors for unintended pregnancy. Of the 518, 420 had their viral load
monitored, from which we determined the risk factors for detectable viral load. These
women were followed up on delivery and at 6 weeks, when 472 mothers and their babies
were included in a prospective cohort analysis to measure barriers and enablers of adherence
to infant nevirapine prophylaxis. The mother-infant pairs were followed up until 14 weeks,
at which point the incidence and risk factors for non-exclusive breastfeeding was
longitudinally measured. Data was analysed using logistic regression models and
generalised estimation equations for the Poisson family.
Results: Of the 518 women enrolled in the study, 213 (41.1%) had unintended pregnancy
(95% Confidence interval (CI): 36.8% - 45.5). Risk factors for unintended pregnancy were
being single (adjusted odds ratio (AOR) = 3.74, 95% CI: 1.67 – 8.34), higher parity (parity
of ≥5; AOR= 2.79, 95% CI: 1.85 – 4.22) and long-term ART (≥10 years; AOR=3.69, 95%
CI: 1.57 – 8.67). Detectable viral load (>50 copies/ml) was prevalent among 120 women
[120/420; 30.7%: 95% CI: 26.3 - 35.4%)] and viral non-suppression (>1000 copies/ml) was
at 8.1% (34/420; 95% CI: 5.7 – 11.1%). Factors associated with detectable viral load that
did not belong to the Lango ethnicity were: (other ethnicity: AOR = 1.92, 95% CI: 1.05 –
3.90), and taking a second-line regimen (protease inhibitor-based: AOR = 4.41, 95% CI:
1.13 – 17.22). A number of the infants did not keep to their nevirapine prophylaxis at 6
weeks of age (70/472; 14.8%, 95% CI: 11.7-18.4%). Barriers to infant adherence were
younger maternal age (≤20 years; adjusted risk ratio (ARR) =1.55; 95% CI: 1.1 – 2.2), did
not take a viral load test during pregnancy (ARR: 1.4; 95% CI: 1.1 – 1.7), and mothers not
receiving nevirapine syrup for the baby after childbirth (ARR = 6.2; 95% CI: 5.1 – 7.6).
Enablers were maternal characteristics including: having attained ≥14 years of schooling (ARR = 0.7; 95% CI: 0.5 – 0.9), taking a nevirapine-based regimen (ARR = 0.6; 95% CI:
0.4 – 0.9), being on long-term ART (≥ 60 months ARR = 0.75; 95% CI: 0.6 – 0.9), being
accompanied by a husband to hospital during labour and childbirth (ARR = 0.5; 95% CI:
0.4 – 0.7) and labour pains starting at night (ARR = 0.7; 95% CI: 0.6 – 0.8). The rate of
exclusive breastfeeding decreased with increasing age of the infants, and by 14 weeks of age
almost half were not exclusively breastfeeding (200/466; 42.9%, 95% CI: 38.3-47.5%). Risk
factors for non-exclusive breastfeeding included the mother: belonging to the highest
socioeconomic strata (ARR = 1.5, 95% CI: 1.01 – 2.1), delivering under the supervision of a
non-health worker (ARR=1.6, 95% CI: 1.01 – 2.7), and the mother not adhering to her ART
during pregnancy (ARR=1.3, 95% CI: 1.01 – 1.7).
Conclusion: HIV infected women at risk of infecting their infants include the younger age
group, unmarried, non-native to Lira, non-adherent to ART, have recently just began taking
ART, had deliveries unsupervised by a health worker, and those that did not receive
nevirapine syrup for their infant after childbirth. We recommend that attention should be
focused on these critical groups during the implementation of PMTCT programs in Lira,
Northern Uganda and in contexts similar to it. | en_US |
