HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI‐PMTCT study

Abstract

Introduction Published data on viral suppression among pregnant and breastfeeding women in routine care settings are scarce. Here, we report provincial estimates of undetectable and suppressed viral load among pregnant or breastfeeding women in HIV care in Kinshasa, Democratic Republic of Congo (DRC) and associated risk factors. Methods This cross‐sectional study was conducted as part of a baseline assessment for the CQI‐PMTCT study: an ongoing cluster randomized trial to evaluate the effect of continuous quality interventions (CQI) on long‐term ART outcomes among pregnant and breastfeeding women (NCT03048669). From November 2016 to June 2018, in each of the 35 Kinshasa provincial health zones (HZ), study teams visited the three busiest maternal and child health clinics, enrolled all HIV‐positive pregnant or breastfeeding women (≤1 year post‐delivery) receiving ART, and performed viral load testing. Log binomial models with generalized estimating equations to account for clustering at the HZ level, were used to estimate prevalence ratios comparing participants with undetected (<40 copies/mL) or suppressed (<1000 copies/mL) viral load across levels of individual and site characteristics. Results Of the 1752 eligible women, 1623 had viral load results available, including 38% who had been on ART for <6 months and 74% were on tenofovir‐lamivudine‐efavirenz. Viral load was undetectable in 53% of women and suppressed in 62%. Among women who were on ART for ≥12 months, only 60% and 67% respectively, had undetectable or suppressed viral load. Viral load was undetectable in 53%, 48% and 58% of women testing during pregnancy, at delivery, and in postpartum respectively. In multivariable log binomial models, duration of ART >12 months, older age, being married, disclosure of HIV status, receiving care in an urban health zone or one supported by PEPFAR were all positively associated with viral suppression. Conclusions The observed high level of detectable viral load suggests that high ART coverage alone without substantial efforts to improve the quality of care for pregnant and breastfeeding women, will not be enough to achieve the goal of virtual elimination of vertical HIV transmission in high‐burden and limited resources settings like DRC.

Early post-partum viremia predicts long-term non-suppression of viral load in HIV-positive women on ART in Malawi: Implications for the elimination of infant transmission

“…We additionally report that approximately 80% retained in this cohort had durable VLS to 24 months, which will confer increased benefit in preventing HIV transmission during breastfeeding and subsequent pregnancies, as well as preservation of health in mothers. However, the proportion of women achieving durable VLS in our study is higher than that reported in South Africa (70% (<50 copies/mL) at 12 months and 56% at 36-60 months (median 44 months post-partum)) [18] and in Kenya (67% (<1000 copies/mL) at 12months) [19]. These differences may be explained by diverse proportions of retention and loss to follow-up across these different settings, including that women retained to 24 months in our study may not reflect population-level VLS among all post-partum Malawian women.…”

Arresting Vertical Transmission of Hepatitis B Virus (AVERT-HBV) in the Democratic Republic of the Congo

“…While LTFU negatively impacts our ability to determine incidence of MTCT, it is an expected feature of pragmatic feasibility studies and consistent with postnatal follow-up patterns in the DRC. 18 Wealth quartiles were calculated from a principal component analysis including the following variables: people per household room, number of beds in household, number of radios in household, number of televisions in household, number of phones in household, number of refrigerators in household, ownership of a car, presence/absence of electricity in household, cooking with electricity, cooking with wood, and private water source.…”

“…While LTFU negatively impacts our ability to determine incidence of MTCT, it is an expected feature of pragmatic feasibility studies and consistent with postnatal follow-up patterns in the DRC. 18 Fourth, supply chain disruption prevented us from completing planned laboratory comparisons of HBeAg and viral load testing on DBS versus venous blood in-country. The COVID-19 pandemic bears some responsibility for these challenges, but nascent HBV laboratory reagent supply chains are also to blame.…”

“…A principal component analysis was used to combine household attributes into a wealth index similar to other Kinshasa-based studies ( Supplementary Material ). 18 Statistical computations were carried out using R 4.0.3 (R Core Team, Vienna, Austria).…”

HIV-1 subtype C predicted co-receptor tropism in Africa: an individual sequence level meta-analysis

“…The UNAIDS 90-90-90 target translates to 90% of all persons to be tested for HIV, 90% of those infected should be on treatment, and 90% of those on treatment should have their viral load suppressed to undetectable levels. In this scheme, treatment is expected to act as a prevention tool, since the chances of transmission is highly reduced when viral load is undetectable [2][3][4][5]. Combination antiretroviral therapy (cART) is the gold standard for the management of HIV infections.…”