Viral load suppression among pregnant and breastfeeding women living with HIV in Ghana: a prospective longitudinal study

Abstract

The post-delivery period is a critical window for sustaining maternal viral suppression (VS) to prevent vertical transmission (VT) of HIV during breastfeeding. Despite Ghana’s national scale-up of dolutegravir-based antiretroviral therapy, limited data exist on viral load suppression and infant HIV outcomes in the year post-delivery. We aimed to determine the proportion of women who achieved and maintained a suppressed viral load (VL) (≤ 1000 copies/mL) and an undetectable VL (< 20 copies/mL) at 12 months post-delivery and examine associations between maternal characteristics and VL categories. We conducted a prospective longitudinal cohort study among 120 women living with HIV receiving ART across two tertiary hospitals in Ghana. Women were enrolled during late pregnancy or early post-delivery and followed up at 6 weeks and 3-, 6-, and 12-months post-delivery, during which maternal VL was monitored. Infant HIV status was documented at 6 weeks and 9 months in accordance with national guidelines. Our co-primary outcomes were VL suppression and undetectable VL at 12 months. The median maternal age was 31.0 years (28.0, 36.3), and nearly half of the participants had attained only primary-level education (58/120; 46.7%). At 12 months post-delivery, 65 participants (54.2%) had documented VS, and out of this, 41 (34.2%) had an undetectable VL. Two cases of VT of HIV were documented: one at 6 weeks (maternal VL 669 copies/mL) and another at 6 months (maternal VL 64 copies/mL), underscoring the transmission risk even with low-level viremia. VL data were missing among 49 participants (40.8%) despite follow-up efforts. Women on the tenofovir/lamivudine/dolutegravir regimen were more likely to achieve suppression than were those on the regimen without an integrase inhibitor, p = 0.04. Just over half of women achieved VS at 12 months post-delivery. VT occurred even at low levels of maternal viremia, underscoring the importance of sustained VL monitoring and optimisation of antiretroviral therapy during the post-delivery period. Not applicable.