HIV-positive women are particularly vulnerable to poor retention and ART adherence in the postpartum period with low viral suppression that poses risks to maternal health and to transmission of HIV to their infants. We assessed the effect of a multidisciplinary integrated management team intervention on viral suppression in a cohort of HIV-positive pregnant women in Lesotho.
The IMPROVE cluster randomized study evaluated an intervention that included a multidisciplinary management team with maternal child health staff, village health workers, and peer mentor mothers to work together to support HIV-positive and negative women in uptake and retention in HIV and MCH services. Training together, using job aids, and adding early home based follow-up of new ANC attendees were included in the intervention. Twelve facilities were randomized to intervention or control arms. HIV-positive pregnant women were enrolled at their first ANC visit with prospective follow-up for at least 12 months postpartum. Study nurses conducted interviews with participants, extracted medical record information and collected dried (whole) blood spots from HIV-positive women for viral load testing. We compared viral load (VL) results at 12 months postpartum using Chi-square tests to test for differences between study arms.
613 HIV-positive women were enrolled in the study, 308 in the interventional arm and 305 in the control arm. 570 women had delivery information, all of whom were on ART at the time of delivery. VL results from 11-15 months postpartum were available for 351 (57%) women. There was no difference in follow-up (pregnancy losses/stillbirths, transfer to facilities outside the district, and loss to follow-up) by study arm. Overall 325 (93%) women were suppressed with a VL <1000 copies/ml. A greater proportion of women in the intervention group had a suppressed VL (166/175, 95%) compared to women in the control arm (159/176, 90%) but the difference was not statistically significant (p=0.106). Significantly more women in the intervention group had an undetectable viral load (83% intervention vs. 72% control, p=0.016).
The multi-component IMPROVE intervention led to a small but not significant increase in viral suppression in HIV positive women one year after delivery, with high rates of suppression in both arms.