Factors Associated with Peripartum Virologic Suppression in the Eastern Cape Province, South Africa: A Retrospective Cross-sectional Analysis.

BACKGROUND This study describes the characteristics of pregnant women on ART and the rate of peripartum virologic suppression in a large PMTCT cohort who delivered in some selected maternity centres in the Eastern Cape Province, South Africa. In addition, the study examines the factors associated with virologic suppression in the cohort. METHODS This multi-centre retrospective cross-sectional analysis included medical data of 1709 women with HIV between September 2015 - May 2016 in the Eastern Cape Province. The main outcome measure was the rate of peripartum virologic suppression defined as viral load (VL) <1000 copies/mL and undetectable viraemia (VL <20 copies/mL). Correlates of peripartum virologic suppression and undetectable viraemia were examined by fitting logistic regression model analysis. RESULTS Out of 1463 women with available VL results, the overall rate of peripartum suppression was 82%, and undetectable viraemia was 56.9%. Being aged 24 years or below [AOR=0.68, CI=0.48-0.94], smoking during pregnancy [AOR=0.50, CI=0.28-0.90], and starting ART in the first trimester were associated with lower odds of viral suppression (<1000 copies/mL). Women who had never defaulted ART had an increased odds of having an undetectable viral load [AOR=3.09, CI=2.12-4.49] and virologic suppression [AOR=3.88, CI=2.62-5.74] compared to those who defaulted. CONCLUSIONS Over half of the women achieved undetectable viral load, and four in five women achieved viral suppression at delivery in the region. Early antenatal booking combined with enhanced adherence support for pregnant women on ART would be crucial towards achieving the goal of elimination of MTCT in the region.