Journal Article

Viral load testing among women on ‘option B+’ in Mazowe, Zimbabwe: How well are we doing?

Mushavi, Angela, Chimwaza, Anesu, Mugurungi, Owen, Senkoro, Mbazi, Nyakura, Justice, Mukungunugwa, Solomon Huruva, Shewade, Hemant Deepak, Ade, Serge, Owiti, Philip

2019

Overview

Globally, ten percent of new HIV infections are among children and most of these children acquire infection through mother-to-child transmission. To prevent this, lifelong ART among pregnant and breast feeding (PBF) women living with HIV, irrespective of the WHO clinical stage, was adopted (option B+). There is limited cohort-wise assessment of VL testing among women on 'option B+'. Among a pregnancy cohort on antiretroviral therapy in public hospitals and clinics of Mazowe district, Zimbabwe (2017), to determine the i) proportion undergoing VL testing anytime up to six months post child birth and associated factors; ii) turnaround time (TAT) from sending the specimen to results receipt and VL suppression among those undergoing VL testing. This was a cohort study involving secondary programme data. Modified Poisson regression using robust variance estimates was used to determine the independent predictors of VL testing. Of 1112 women, 354 (31.8%, 95% CI: 29.2-34.6) underwent VL testing: 113 (31.9%) during pregnancy, 124 (35%) within six months of child birth and for 117 (33.1%), testing period was unknown. Of 354, VL suppression was seen in 334 (94.4%) and 13 out of 20 with VL non-suppression underwent repeat VL testing. Among those with available dates (125/354), the median TAT was 93 days (IQR 19.3-255). Of 1112, VL results were available between 32 weeks and child birth in 31 (2.8%) women. When compared to hospitals, women registered for antenatal care in clinics were 36% less likely to undergo VL testing [aRR: 0.64 (95% CI: 0.53, 0.76)]. Among women on option B+, the uptake of HIV VL testing was low with unacceptably long TAT. VL suppression among those tested was satisfactory. There is an urgent need to prioritize VL testing among PBF women and to consider use of point of care machines. There is a critical need to strengthen the recording and local utilisation of routine clinic data in order to successfully monitor progress of healthcare services provided.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / AIDS / Anti-HIV Agents - administration & dosage / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Biology and Life Sciences / Birth / Breast feeding / Breastfeeding & lactation / Childbirth & labor / Children / Cohort Studies / Disease prevention / Disease transmission / Female / Health aspects / Health care industry / Highly active antiretroviral therapy / HIV / HIV - drug effects / HIV - isolation & purification / HIV infections / HIV Infections - diagnosis / HIV Infections - drug therapy / HIV Infections - transmission / HIV Infections - virology / HIV tests / Hospitals / Human immunodeficiency virus / Humans / Infection / Infections / Infectious Disease Transmission, Vertical - prevention & control / Machinery / Mass Screening - statistics & numerical data / Medical tests / Medicine and Health Sciences / Middle Aged / People and Places / Poisson density functions / Pregnancy / Pregnant women / Prenatal Care - statistics & numerical data / Public hospitals / Robustness (mathematics) / Statistical analysis / Tat protein / Test procedures / Tuberculosis / Viral Load - drug effects / Women / Womens health / Young Adult / Zimbabwe