Abstract:
Problem statement - The transmission of HIV from pregnant mothers to their children has significantly decreased in the past two decades, especially since the introduction of the B+ option in 2013. Mothers with an undetectable viral load pose zero risk of transmitting HIV to their fetuses. However, there is limited information about the status of HIV viral suppression among pregnant mothers in countrywide level. Understanding the viral suppression in pregnant women will indirectly help us understand the current status of vertical transmission of HIV and develop appropriate intervention strategies.
Objectives- To determine the HIV viral load suppression status and associated factors among pregnant women in Ethiopia, 2015 EFY.
Methods – cross-sectional study design using secondary data from the national HIV viral load data repository was used. The study population were all pregnant women who started ART and tested for routing HIV viral load. The data extraction process was covered the period between July 2022 to June 2023 (2015 EFY). HIV Viral load results were categorized into unsuppressed (>1000 RNA copies/mL), LLV (50-1000 RNA copies/ml, suppressed (detected but <1000 RNA copies/mL) and Undetectable below the detection limit of the machine). Furthermore, we collected additional patient information from national data bases by targeting the national key indicators. Data was transferred to STATA v.17, and then descriptive (frequency, percentage, mean and standard deviation), and a mixed model for logistic regression were used. The odds ratio was calculated to quantify the strength of the association. Variables that show a significant association with the outcome (p < 0.02) were selected for further analysis using multiple logistic regression models.
Results: The participants' median age was 35 years old, ranging from 14 to 50. The majority of pregnant women (52.2%) were between the ages of 30 and 40, followed by 19 to 29 years old (25.9%). Nearly all participants (96.2%) were on first-line ART, with smaller percentages on second-line (2.2%) and third-line treatments (1.63%). Regarding testing, 3839 (49.4%) women were tested until the 34th-36th week of gestation, 2573 (33.1%) were tested once during their antenatal care (ANC) visit, and 1352 (17.4%) were tested for the second time at 6 months during the ANC visit. The HIV viral suppression rate among pregnant women before delivery was 96.8% in this study. Of the suppressed results, 96.5% of participants had undetectable HIV viral load. The multiple binary logistic regression analysis showed that individuals aged 19-29 had 3.17 times higher odds (AOR = 3.17, 95% CI = 1.17-5.17, p = 0.002) of having an unsuppressed viral load compared to those under 19. Additionally, individuals with poor adherence to treatment had 12.6 times higher odds of developing an unsuppressed viral load (AOR = 12.64, 95% CI = 10.74-14.54, p = 0.000). However, there was no significant association between time for viral load testing with unsuppressed maternal HIV viral load.
Conclusion: High prevalence of first-line ART treatment among pregnant women, with a notable achievement of 96.8% HIV viral suppression rate before delivery. The findings underscore the importance of targeted efforts to improve adherence and support younger pregnant women to maintain viral suppression. These findings have important implications for policy and clinical practices aimed at improving the health outcomes of mothers and newborns affected by HIV/AIDS.
............. Thesis available at ACIPH Library