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Viral suppression and factors associated with failure to achieve viral suppression among pregnant women in South Africa
- Source :
- AIDS (London, England)
- Publication Year :
- 2019
-
Abstract
- Supplemental Digital Content is available in the text<br />Objective: To describe viral load levels among pregnant women and factors associated with failure to achieve viral suppression (viral load ≤50 copies/ml) during pregnancy. Design: Between 1 October and 15 November 2017, a cross-sectional survey was conducted among 15–49-year-old pregnant women attending antenatal care (ANC) at 1595 nationally representative public facilities. Methods: Blood specimens were taken from each pregnant woman and tested for HIV. Viral load testing was done on all HIV-positive specimens. Demographic and clinical data were extracted from medical records or self-reported. Survey logistic regression examined factors associated with failure to achieve viral suppression. Result: Of 10 052 HIV-positive participants with viral load data, 56.2% were virally suppressed. Participants initiating antiretroviral therapy (ART) prior to pregnancy had higher viral suppression (71.0%) by their third trimester compared with participants initiating ART during pregnancy (59.3%). Booking for ANC during the third trimester vs. earlier: [adjusted odds ratio (AOR) 1.8, 95% confidence interval (CI):1.4–2.3], low frequency of ANC visits (AOR for 2 ANC visits vs. ≥4 ANC visits: 2.0, 95% CI:1.7–2.4), delayed initiation of ART (AOR for ART initiated at the second trimester vs. before pregnancy:2.2, 95% CI:1.8–2.7), and younger age (AOR for 15–24 vs. 35–49 years: 1.4, 95% CI:1.2–1.8) were associated with failure to achieve viral suppression during the third trimester. Conclusion: Failure to achieve viral suppression was primarily associated with late ANC booking and late initiation of ART. Efforts to improve early ANC booking and early ART initiation in the general population would help improve viral suppression rates among pregnant women. In addition, the study found, despite initiating ART prior to pregnancy, more than one quarter of participants did not achieve viral suppression in their third trimester. This highlights the need to closely monitor viral load and strengthen counselling and support services for ART adherence.
- Subjects :
- 0301 basic medicine
Adult
Epidemiology and Science
medicine.medical_specialty
viral suppression
Time Factors
Adolescent
Anti-HIV Agents
timing of antiretroviral therapy initiation
Immunology
Population
HIV Infections
Logistic regression
03 medical and health sciences
South Africa
Young Adult
0302 clinical medicine
Pregnancy
medicine
Immunology and Allergy
Humans
030212 general & internal medicine
Viral suppression
Pregnancy Complications, Infectious
education
education.field_of_study
business.industry
Obstetrics
Medical record
Prenatal Care
Odds ratio
Middle Aged
Viral Load
medicine.disease
Confidence interval
Infectious Disease Transmission, Vertical
3. Good health
030104 developmental biology
Infectious Diseases
Cross-Sectional Studies
Logistic Models
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Female
antenatal survey
business
Viral load
pregnant women
Subjects
Details
- ISSN :
- 14735571
- Volume :
- 34
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- AIDS (London, England)
- Accession number :
- edsair.doi.dedup.....3e5f60b47e6855e53c99aff1eb77a273