1. Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study
- Author
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Nora E. Rosenberg, Christopher Stanley, Salem Gugsa, Michael Eliya, Hannock Tweya, Levison Chiwaula, Erik Schouten, Fabian Cataldo, Kara Compliment, Sam Phiri, Monique van Lettow, Veena Sampathkumar, Blessings Kaunda-Khangamwa, Mina C. Hosseinipour, Virginia Kayoyo, Florence Kasende, Sarah E. Rutstein, Clement Trapence, Atupele Kapito-Tembo, Julie A. E. Nelson, and Frank Chimbwandira
- Subjects
Adult ,0301 basic medicine ,Malawi ,Pediatrics ,medicine.medical_specialty ,Maternal-Child Health Services ,Anti-HIV Agents ,Drug Resistance ,Breastfeeding ,HIV Infections ,World Health Organization ,Article ,Medication Adherence ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Pregnancy ,law ,Cluster Analysis ,Humans ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Young adult ,Reverse-transcriptase inhibitor ,business.industry ,Infant, Newborn ,Odds ratio ,Viral Load ,030112 virology ,Infectious Disease Transmission, Vertical ,CD4 Lymphocyte Count ,Breast Feeding ,Infectious Diseases ,Female ,business ,Breast feeding ,Viral load ,HIV drug resistance ,Program Evaluation ,medicine.drug - Abstract
BACKGROUND In 2011, Malawi launched Option B+, a program of universal antiretroviral therapy (ART) treatment for pregnant and lactating women to optimize maternal health and prevent pediatric HIV infection. For optimal outcomes, women need to achieve HIVRNA suppression. We report 6-month HIVRNA suppression and HIV drug resistance in the PURE study. METHODS PURE study was a cluster-randomized controlled trial evaluating 3 strategies for promoting uptake and retention; arm 1: Standard of Care, arm 2: Facility Peer Support, and arm 3: Community Peer support. Pregnant and breastfeeding mothers were enrolled and followed according to Malawi ART guidelines. Dried blood spots for HIVRNA testing were collected at 6 months. Samples with ART failure (HIVRNA ≥1000 copies/ml) had resistance testing. We calculated odds ratios for ART failure using generalized estimating equations with a logit link and binomial distribution. RESULTS We enrolled 1269 women across 21 sites in Southern and Central Malawi. Most enrolled while pregnant (86%) and were WHO stage 1 (95%). At 6 months, 950/1269 (75%) were retained; 833/950 (88%) had HIVRNA testing conducted, and 699/833 (84%) were suppressed. Among those with HIVRNA ≥1000 copies/ml with successful amplification (N = 55, 41% of all viral loads > 1000 copies/ml), confirmed HIV resistance was found in 35% (19/55), primarily to the nonnucleoside reverse transcriptase inhibitor class of drugs. ART failure was associated with treatment default but not study arm, age, WHO stage, or breastfeeding status. CONCLUSIONS Virologic suppression at 6 months was
- Published
- 2017
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