Durability of HIV Viral Load Suppression among Postpartum Women in 13 Countries in Sub-Saharan Africa Restricted; Files Only

Abstract

Achieving and retaining HIV viral load suppression (VLS) in the postpartum period is especially difficult for mothers, despite the implementation of Option B+ and other high coverage and long-lasting HIV treatment options. This has important implications for their health and the health of their children and partners. In this study, we analyzed data from the Population-Based HIV Impact Assessment (PHIA) to determine the durability of VLS in the first three years postpartum. We identified VLS by three different cutoffs: <1000 copies/mL (epidemiologically suppressed), <200 copies/mL (low-level viremia, previous standard for undetectable), and <50 copies/mL (new standard for undetectable). We used HIV testing weights pooled across all 13 countries to estimate the percentage of viral suppression and log-binomial regression to estimate crude prevalence ratios at each of the VLS cutoffs. We also utilized logistic regression to incorporate demographic and behavioral factors into our estimates. In all analyses, there was a demonstrated drop-off from year 1 postpartum to year 2, and further drop-offs by year 3. Even when accounting for confounding factors, the trend remained the same for all levels of VLS. There were no differences in VLS outcomes by breastfeeding status, parity, or awareness of HIV status at the time of pregnancy. These findings demonstrate the need for additional support and care for women in the postpartum period, especially after the first year postpartum. Resources should be applied to all mothers, regardless of demographic or reproductive factors, and should be used to support mothers no matter how recently they delivered. However, because the reduction in VLS continues over time, additional support may be necessary later in the postpartum period.  

Table of Contents

Introduction 1

Methods 2

Results 6

Discussion 7

References 12

Tables 17

Supplemental Tables 23

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	prevention of mother-to-child transmission HIV postpartum HIV during pregnancy HIV HIV and breastfeeding HIV in sub-Saharan Africa HIV viral load suppression
Committee Chair / Thesis Advisor	Sullivan, Patrick S, Emory University
Committee Members	Voetsch, Andrew C, CDC
Partnering Agencies	CDC Georgia state or local health department

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