Viral Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda.
BACKGROUND
Lifelong antiretroviral therapy (ART) is recommended for all HIV-infected pregnant women, but early studies suggest that women often drop out of care postpartum and data are limited on virologic outcomes.


METHODS
We evaluated viral suppression (primary outcome) and retention in care up to 5 years after ART initiation among HIV-infected women who started lifelong ART during pregnancy, irrespective of CD4 count, in a study in rural Uganda (NCT00993031). Participants were followed in the study for up to 1 year postpartum, then referred to clinics in surrounding communities. A random sample (N = 200) was invited to participate in a cross-sectional follow-up study after completing the trial, involving one visit for a questionnaire and pregnancy and HIV-1 RNA testing. Retention in care was defined as having attended an HIV clinic in the last 90 days. Logistic regression models were used to examine factors associated with viral suppression (HIV-1 RNA <400 copies/ml) at follow-up.


RESULTS
One hundred fifty women (75%) were successfully contacted for follow-up at a median of 4.2 years after starting ART; 135 were retained in care [90%, 95% confidence interval (CI): 84.0% to 94.3%] and 121 demonstrated viral suppression (80.7%, 95% CI: 73.4% to 86.7%). Women who had disclosed their HIV status to their primary partner had greater odds of viral suppression (adjusted odds ratio: 4.51, 95% CI: 1.02 to 19.8).


CONCLUSIONS
High rates of viral suppression can be achieved up to 5 years after initiating ART during pregnancy among women retained in care. Interventions to facilitate disclosure may improve long-term outcomes among women who initiate ART during pregnancy under universal treatment.
*Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA; †Makerere University-University of California, San Francisco Research Collaboration, Kampala, Uganda; ‡Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; §Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA; and ‖Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Catherine A
CA
Koss
Paul
P
Natureeba
Dalsone
D
Kwarisiima
Mike
M
Ogena
Tamara D
TD
Clark
Peter
P
Olwoch
Deborah
D
Cohan
Jaffer
J
Okiring
Edwin D
ED
Charlebois
Moses R
MR
Kamya
Diane V
DV
Havlir
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D055118:Medication Adherence; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012367:RNA, Viral / Q000097:blood; D012424:Rural Population; D011795:Surveys and Questionnaires; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D014454:Uganda
D044966:Anti-Retroviral Agents; D012367:RNA, Viral