Correlates of HIV virological suppression among pregnant women; case study: Zombo District – West Nile region, Uganda

Abstract

Background: Pregnant women living with HIV, are responsible for about 200,000 new HIV cases annually, because of non-virological suppression among more than 10% of them (less than 90%). The population of pregnant women living with HIV is of great importance in the achievement of the 2020 UNAIDS targets because it is not only responsible for thousands of new HIV cases if not suppressed, but also thousands of more new future cases (close to 100,000) due to heterosexual transmissions from perinatally infected children. . Objective: The purpose of the study was to determine the prevalence and correlates of virological suppression among pregnant women in Zombo district – West Nile region, Uganda Methods: The study adopted an analytical cross sectional survey design, in studying mothers living with HIV in Zombo district. The district was purposively sampled, a census made for the health centers, and mothers thereat consecutively sampled. Structured interviews and data abstraction were used to collect data, which was analyzed in SPSS version 25 using descriptive statistics and the robust Poisson distribution. Results: More than three quarters of the mothers were virally suppressed during their most recent pregnancy 86% (202/234). The prevalence of viral suppression was 15.9% higher among moslem mothers (aPR = 1.159, CI = 1.015 - 1.322, P = 0.029), 23.8% higher among mothers who were married (aPR = 1.238, CI = 1.129 - 1.357 P = <0.001), 10.9% higher among mothers who were para 2 (aPR = 1.109, CI = 1.019 - 1.208, P = 0.017) and 9.2% higher among mothers who had disclosed their HIV status to their partners (aPR = 1.092, CI = 1.013 - 1.178, p = 0.021). The prevalence of virological suppression was 21.3% higher among mothers who had skipped a day without taking ARV medication (aPR = 1.213, CI = 1.087 - 1.353, P = 0.001) during pregnancy, 18.3% higher among mothers who had missed any medical appointments during pregnancy (aPR = 1.183, CI = 1.055 - 1.326, P = 0.004), and 22.4% higher among mothers who reported that they had taken mineral and vitamin supplements during pregnancy (aPR = 1.224 (1.091 - 1.373, p = 0.001). It was less among mothers who had a TB infection during pregnancy (aPR = 0.895, CI = 0.850 - 0.942, P = <0.001), but 11% higher among mothers whose WHO clinical stage during pregnancy was WHO Stage 1 (aPR = 1.110, CI = 1.045 - 1.178, p = 0.001). Conclusion: Although fairly high, HIV virological suppression during pregnancy among women in Zombo district is still 4% points lower than the 2020 target for viral suppression, and 14 percentage points away from universality. Up to 2 in 10 pregnant women in Zombo district are not virally suppressed by the end of their pregnancies. Viral suppression among those women in the district is determined almost in equal measure by individual and clinical characteristics of the women Recommendation: Intensive adherence and counseling should be further augment for all pregnant women who default any medical appointment, vitamin and mineral supplementation should be promoted and TB preventive therapy provided to all pregnant women in the PMTCT programs.