Retention and viral suppression of newly diagnosed and known HIV positive pregnant women on Option B+ in Western Kenya

Akama, Eliud; Nimz, Abigail; Blat, Cinthia; Moghadassi, Michelle; Oyaro, Patrick; Maloba, May; Cohen, Craig R.; Bukusi, Elizabeth A.; Abuogi, Lisa

doi:10.1080/09540121.2018.1524565

Cited by 11 publications

(12 citation statements)

References 17 publications

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“…[1] The goal of ART is to suppress maternal viral load (VL) to substantially lower risk of transmitting the virus to their infant during pregnancy [2][3][4][5][6] and breastfeeding. [7,8] However, in several Sub-Saharan African PMTCT study populations, the proportions of pregnant women with unsuppressed VL range from 6.1-15.4%, [9][10][11][12][13] with 9.4-22% experiencing postpartum episodes of virologic rebound [14,15]. This is consistent with the reported postpartum dropoff in Option B+ ART adherence.…”

Section: Introductionsupporting

confidence: 72%

“…Very limited prior data on VL testing uptake in Sub-Saharan African PMTCT programs suggest that only 35-50% of pregnant women on lifelong ART regimens receive any VL testing. [9,10,22] We are aware of no prior reports tracking the uptake of a consecutive baseline and repeat VL test sequence that fulfills PMTCT guidelines. Our data show that more than 70% of women in these four Kenyan facilities received a baseline VL test sometime during PMTCT, superior to the uptake levels reported previously.…”

Section: Discussionmentioning

confidence: 99%

“…Our data show that more than 70% of women in these four Kenyan facilities received a baseline VL test sometime during PMTCT, superior to the uptake levels reported previously. [9,10,22] However, only 6% of women received a baseline and repeat testing sequence adherent to the schedule in Kenya's guidelines. Though, significant variations were observed in the uptake of guideline-adherent testing across study sites and between the newly ART-initiated and previously initiated patient populations, no site achieved more than 11% guideline adherent testing sequence for newly or previously diagnosed patients.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21] Results of studies from Senegal, Mozambique, and Kenya indicate that uptake of VL testing among pregnant women receiving ART are low: ranging from 36%-57%. [9,10,22] To the best of our knowledge, no studies to date have evaluated actual VL monitoring against the recommended guidelines to assess the timing of VL monitoring and compliance with repeat testing.…”

Section: Introductionmentioning

confidence: 99%

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Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

et al. 2020

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Background Kenya's guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women. Method We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result. Results Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for 79 (19%). Only 115 women (27%) received a guideline-adherent baseline VL test and 27 (6%) received a guideline-adherent baseline and repeat VL test sequence. Return of baseline and repeat VL test results to the facility was high (average 96%), but patient notification of VL results was low (36% baseline and 49% repeat). Clinical action for unsuppressed VL results was even lower: 11 of 38 (29%) unsuppressed baseline results and 2 of 14 (14%) unsuppressed repeat results triggered clinical action. Discussion Guideline-adherent VL testing and clinical intervention during PMTCT must be prioritized to improve maternal care and reduce the risk of HIV transmission to infants.

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Section: Introductionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

et al. 2020

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“…To date, multiple studies have examined retention in the PMTCT continuum in sub-Saharan Africa. These studies have identified a variety of barriers to retention, including younger age, HIV-related stigma and fear of disclosure, low socioeconomic status, inadequate social support, and negative healthcare worker attitude [1,[10][11][12][13][14][15][16][17][18][19][20][21][22]. However, many of these studies were conducted prior to the WHO 'Treat All' policy of universal ART eligibility in 2015 [23,24].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV

Humphrey

Alera

Kipchumba

et al. 2021

PLOS Glob Public Health

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Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well described. We explored these factors within an enhanced sub-cohort of the East Africa International Epidemiology Databases to Evaluate AIDS Consortium. From 2018–2019, a purposeful sample of PPHIV ≥18 years of age were recruited from five maternal and child health clinics providing integrated PMTCT services in Kenya. Women retained in care were recruited at the facility; women who had become LTFU (last visit >90 days) were recruited through community tracking. Interview transcripts were analyzed thematically using a social-ecological framework. Forty-one PPHIV were interviewed. The median age was 27 years, 71% were pregnant, and 39% had become LTFU. In the individual domain, prior PMTCT experience and desires to safeguard infants’ health enhanced retention but were offset by perceived lack of value in PMTCT services following infants’ immunizations. In the peer/family domain, male-partner financial and motivational support enhanced retention. In the community/society domain, some women perceived social pressure to attend clinic while others perceived pressure to utilize traditional birth attendants. In the healthcare environment, long queues and negative provider attitudes were prominent barriers. HIV-related stigma and fear of disclosure crossed multiple domains, particularly for LTFU women, and were driven by perceptions of HIV as a fatal disease and fear of partner abandonment and abuse. Both retained and LTFU women perceived that integrated HIV services increased the risk of disclosure. Retention was influenced by multiple factors for PPHIV. Stigma and fear of disclosure were prominent barriers for LTFU women. Multicomponent interventions and refining the structure and efficiency of PMTCT services may enhance retention for PPHIV.

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Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017

et al. 2021

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Background: HIV incidence among women of reproductive age and vertical HIV transmission rates remain high in Latin America. We, therefore, quantified HIV care continuum barriers and outcomes among pregnant women living with HIV (WLWH) in Latin America. Methods: WLWH (aged ≥16 years) enrolling at Caribbean, Central and South America network for HIV epidemiology (CCA-SAnet) sites from 2000 to 2017 who had HIV diagnosis, pregnancy and delivery dates contributed. Logistic regression produced adjusted odds ratios (aOR) and 95% confidence intervals (CI) for retention in care (≥2 visits ≥3 months apart) and virological suppression (viral load <200 copies/mL) 12 months after pregnancy outcome. Cumulative incidences of loss to follow-up (LTFU) postpartum were estimated using Cox regression. Evidence of HIV status at pregnancy confirmation was the exposure. Covariates included pregnancy outcome (born alive vs. others); AIDS diagnosis prior to delivery; CD4, age, HIV-1 RNA and cART regimen at first delivery and CCASAnet country. Results: Among 579 WLWH, median postpartum follow-up was 4.34 years (IQR 1.91, 7.35); 459 (79%) were HIV-diagnosed before pregnancy confirmation, 445 (77%) retained in care and 259 (45%) virologically suppressed at 12 months of postpartum. Cumulative incidence of LTFU was 21% by 12 months and 40% by five years postpartum. Those HIV-diagnosed during pregnancy had lower odds of retention (aOR = 0.58, 95% CI: 0.35 to 0.97) and virological suppression (aOR = 0.50, 95% CI: 0.31 to 0.82) versus those HIV-diagnosed before. Conclusion: HIV diagnosis during pregnancy was associated with poorer 12-month retention and virological suppression. Young women should be tested and linked to HIV care earlier to narrow these disparities.

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Retention and viral suppression of newly diagnosed and known HIV positive pregnant women on Option B+ in Western Kenya

Cited by 11 publications

References 17 publications

Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals

A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV

Timing of HIV diagnosis relative to pregnancy and postpartum HIV care continuum outcomes among Latin American women, 2000 to 2017

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