Background
Perinatal HIV transmission has not meaningfully declined in Kenya since 2015. VL monitoring can both reinforce good adherence and enable timely intervention if viremia is detected early. However, in routine care in Kenya, time from sample collection to results to patients is often weeks when VL is detected and months when suppressed. We assessed the feasibility of engaging Mentor Mothers (peer counselors) in rapid return of VL results and factors associated with time required for this approach.
Methods
From May-Dec 2023 we enrolled women between 27 weeks gestation and 6 months postpartum from 4 facilities in Kisumu Kenya. We tested VL via GeneXpert at 1-2 time points. Mentor Mothers returned results to participants and were reimbursed for phone minutes. We tracked times of sample collection, delivery to lab, test resulted, and result return to study team, mentor mother, and participant. Participant VL histories were collected from records. We assessed factors associated with time from sample collection to result return to participants, via unadjusted and adjusted generalized estimating equations with log-transformed time as the outcome. We exponentiated coefficients to report geometric mean ratios (GMR).
Results
From 273 participants (47% pregnant), we tested 422 blood samples of which Mentor Mothers delivered 414 (98%) VL results via phone and 2% in person. VL was ≤40, 41-999, and ≥1000 copies/mL in 90%, 6%, and 4% of samples, respectively. Median time from collection to result return to participants was 27 hours (interquartile range [IQR] 23-55). The slowest step was lab result to study team (median 15 hours, IQR 13-17), as processing was often done after hours. The step with the greatest time variability was Mentor Mother to participant (median 5 hours, IQR 1-25). Study VL results were not associated with time (collection to participant), though VL ≥1000 copies/mL trended towards faster return (GMR 0.8, 95% CI 0.6-1.1; Table). However, viremia in the past year was associated with longer times (GMR 1.3, 95%CI 1.1-1.5). Samples collected on Fridays took 2.0 times (95%CI 1.6-2.6; Table) longer than Monday-Thursday (which were comparable to each other); clinics without GeneXpert on site took 1.8 times longer than when the lab was co-located (95%CI 1.6-2.0).
Conclusions
Mentor Mothers delivered VL results to pregnant and postpartum women in just over 1 day on average. This low-cost approach could complement other strategies to enhance VL monitoring and support optimal adherence.
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