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PLoS One. 2018 Dec 13;13(12):e0209052. doi: 10.1371/journal.pone.0209052. eCollection 2018.

Prevalence of antiretroviral therapy treatment failure among HIV-infected pregnant women at first antenatal care: PMTCT Option B+ in Malawi.

Author information

1
UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi.
2
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America.
3
Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
4
Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
5
Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.

Abstract

BACKGROUND:

In Malawi's PMTCT Option B+ program, HIV-infected pregnant women who are already receiving ART are continued on their current therapy regimen without testing for treatment failure at the first antenatal care (ANC) visit. HIV RNA screening at ANC may identify women with treatment failure and ensure that viral suppression is maintained throughout the pregnancy.

METHODS:

We conducted a cross-sectional study of HIV-infected pregnant women who had been receiving ART for at least 6 months at the first ANC visit under the PMTCT Option B+ program at Bwaila Hospital in Lilongwe, Malawi from June 2015 to December 2017. Poisson regression models with robust variance were used to investigate the predictors of ART treatment failure defined as viral load ≥1000 copies/ml.

RESULTS:

The median age of 864 women tested for ART failure was 31.1 years (interquartile range: 26.9-34.5). The prevalence of treatment failure was 7.6% (95% confidence interval (CI): 6.0-9.6). CD4 cell count (adjusted prevalence ratio (aPR) = 0.57; 95% CI: 0.50-0.65) was strongly associated with treatment failure.

CONCLUSION:

The low prevalence of treatment failure among women presenting for their first ANC in urban Malawi demonstrates success of Option B+ in maintaining viral suppression and suggests progress towards the last 90% of the UNAIDS 90-90-90 targets. Women failing on ART should be identified early for adherence counseling and may require switching to an alternative ART regimen.

PMID:
30543685
PMCID:
PMC6292583
DOI:
10.1371/journal.pone.0209052
[Indexed for MEDLINE]
Free PMC Article

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