Prevalence and determinants of viral load suppression among pregnant women living with HIV, attending first antenatal care visit in South Africa

Abstract

Understanding VL suppression among pregnant women living with HIV (PWLHIV) on antiretroviral therapy (ART) at their first antenatal care (ANC) visit is crucial for improving maternal and child health outcomes, as it can reduce the risk of mother-to-child transmission (MTCT) of HIV. The first ANC visit is a critical opportunity for early identification of health needs, initiation of care, and enhanced support for PWLHIV. This study aimed to estimate the prevalence of VL suppression and identify associated factors among PWLHIV attending their first ANC visit in South Africa. We conducted a secondary data analysis using cross-sectional data from the 2022 ANC HIV Sentinel Survey, focusing on 1,542 PWLHIV on ART at their first ANC visit. We analyzed the prevalence of VL suppression (defined as VL ≤49 copies/mL) using descriptive statistics. Logistic regression was employed to identify factors independently associated with VL suppression in this population. All analyses were weighted to account for the complex survey design, and clustering at the facility level was considered. The median age of participants was 31 years. The sample included women from all provinces: Eastern Cape (11.76%), Free State (5.79%), Gauteng (28.65%), KwaZulu-Natal (24.33%), Limpopo (6.16%), Mpumalanga (8.12%), Northern Cape (1.06%), North West (6.45%), and Western Cape (7.68%). The overall prevalence of VL suppression was 65.89% (95% CI: 63%- 68%). Young women aged 15-24 years and those who booked ANC in the third trimester had significantly higher odds of unsuppressed VL (OR: 1.75, 95% CI [1.25-2.45], p=0.001; OR: 1.96, 95% CI [1.33-2.88], p<0.001). PWLHIV on dolutegravir-based regimens had higher odds of VL suppression. Provincial differences were also observed, with all provinces except Western Cape and Northern Cape showing higher odds of unsuppressed VL compared to Gauteng. The findings underscore the urgent need for targeted interventions to enhance ART adherence and VL monitoring among PWLHIV on ART at first ANC, which is essential for optimizing maternal and child health outcomes in South Africa.