TIME TO VIROLOGIC FAILURE, AND SECOND LINE ART INITIATION AMONG HIV INFECTED PREGNANT AND POSTPARTUM WOMEN RECEIVING OPTION B PLUS PROPHYLAXIS STRATEGY, KAMPALA, UGANDA

Abstract

Background With the continued scale up of the World Health Organization(WHO) option B+ strategy in most of the Sub Saharan African (SAA) countries; there has been notable reduction in HIV related morbidity and mortality among HIV positive women that are initiating ART early. However, data on virologic failure rates and time to 2 nd line ART initiation, which would have been helpful in the assessment of treatment outcomes in this setting, are limited. Methods This was a retrospective cohort study. Data was obtained through chart reviews of HIV positive mothers enrolled between 01 Jan 2015 to 31 Dec 2015, into the Kampala City Council Authority (KCCA) Prevention of Mother-to-Child Transmission (PMTCT) HIV Clinics. Clinical and psychosocial follow up data since 2015 to September 2017 was reviewed. A study specific data collection tool was used to extract the data. Viral load data was verified using the lab register. The data was entered in epi data version 3.0 and analyzed using STATA 13. Descriptive statistics and survival analysis were done. Results Of the 622 charts reviewed, only 182 (29.3%) had at least one viral load post ART initiation. The median age and gravidity of the women were 24 years and 1 respectively. Of the 182 participants, 180 (99 %) were in WHO clinical stage 1 and with a median CD4 cell count of 480 cells/µl. The proportion of those with virologic failure was 15/182 (8.2%). In a 12 months and 18 months period of follow up post ART initiation, the restricted mean survival time was 11.8 (95% CI 11.63-11.98) and 17.2 (95% CI 16.7-17.7) respectively. None had ART regimen switch to 2nd line therapy. Younger age (≤25 years) at enrollment, higher gravidity (≥4), higher gestational age at enrollment and breastfeeding status at 6 months post ART initiation were not significant predictors of virologic failure. However, being single compared to being married was significantly associated with virologic failure in the cox regression analysis. Conclusion For women whose viral load record was available, the proportion having virologic failure was low. It took 12 and 17 months for a woman to develop virologic failure when followed for one year or one and half years. This firmly underscores the need to strengthen adherence support interventions early during the pregnancy, postpartum and beyond. Programs need to reassess the causes of delays to 2nd line switch and ensure timely viral load testing.