Behavioral interventions can mitigate adverse pregnancy outcomes among women conceiving on antiretroviral therapy (ART) and those initiated on ART during pregnancy: Findings from the MOTIVATE trial in southwestern Kenya.

Background Antiretroviral treatment (ART) is essential for the elimination of mother-to-child transmission and improved health outcomes for women living with HIV (WLWH). However, adverse pregnancy outcomes (APO) among pregnant women on ART are a growing concern. Methods We investigated the associations between timing of ART initiation and APO among pregnant WLWH receiving behavioral interventions (community mentor mothers and text messaging) in the Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE) study in southwestern Kenya. Log binomial models were used for estimation of relative risks (RRs) (adjusted for the clustered nature of data) evaluating APO with three exposure comparisons 1) Preconception ART initiation vs. post-conception initiation, 2) among post-conception ART initiating women, comparisons across gestational ages at cART initiation (first versus second and third trimester exposure) and, 3) intervention allocation. Results Of the 1275 women included in this analysis, 388 (30%) had an APO: 306 preterm births, 38 low birth weight infants, 33 stillbirths and 11 miscarriages. In multivariable analysis, viral load >1000 copies/ml, moderate and severe anemia at baseline increased risk of APO. Among women initiating ART before and after conception, no difference was observed in the composite APO. Women who received community mentor mother visits only (aRR 0.74: 95% CI 0.71-0.76), or text messages only (aRR 0.79: 95% CI 0.70-0.89) had lower risks of experiencing any APO. Conclusions Receiving supportive behavioral interventions may mitigate the risk of experiencing an APO among WLWH on ART. Further studies are needed to investigate the underlying mechanisms and optimize the benefits of these interventions.