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

for the CQI-PMTCT study team

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere25376
JournalJournal of the International AIDS Society
Volume22
Issue number9
DOIs
StatePublished - Sep 1 2019
Externally publishedYes

Fingerprint

Breast Feeding
Pregnant Women
HIV
Viral Load
Democratic Republic of the Congo
Urban Health
Quality of Health Care
Disclosure
Statistical Models
Health Status
Cluster Analysis
Cross-Sectional Studies
Health

Keywords

  • HIV
  • option B+
  • pregnant women
  • quality of care
  • treat all
  • universal coverage
  • vertical transmission
  • viral load monitoring
  • viral suppression

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{2fe7f6069a51492f84418c37cbf7b57f,
title = "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.",
keywords = "HIV, option B+, pregnant women, quality of care, treat all, universal coverage, vertical transmission, viral load monitoring, viral suppression",
author = "{for the CQI-PMTCT study team} and Marcel Yotebieng and Christian Mpody and Ravelomanana, {Noro L.R.} and Martine Tabala and Fathy Malongo and Bienvenu Kawende and Paul Ntangu and Frieda Behets and Emile Okitolonda",
year = "2019",
month = "9",
day = "1",
doi = "10.1002/jia2.25376",
language = "English (US)",
volume = "22",
journal = "Journal of the International AIDS Society",
issn = "1758-2652",
publisher = "International AIDS Society",
number = "9",

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TY - JOUR

T1 - HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province

T2 - a baseline evaluation of participants in CQI-PMTCT study

AU - for the CQI-PMTCT study team

AU - Yotebieng, Marcel

AU - Mpody, Christian

AU - Ravelomanana, Noro L.R.

AU - Tabala, Martine

AU - Malongo, Fathy

AU - Kawende, Bienvenu

AU - Ntangu, Paul

AU - Behets, Frieda

AU - Okitolonda, Emile

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

KW - HIV

KW - option B+

KW - pregnant women

KW - quality of care

KW - treat all

KW - universal coverage

KW - vertical transmission

KW - viral load monitoring

KW - viral suppression

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U2 - 10.1002/jia2.25376

DO - 10.1002/jia2.25376

M3 - Article

C2 - 31496051

AN - SCOPUS:85071975278

VL - 22

JO - Journal of the International AIDS Society

JF - Journal of the International AIDS Society

SN - 1758-2652

IS - 9

M1 - e25376

ER -