Human Immunodeficiency Virus (HIV) viral load suppression status and associated factors among pregnant women receiving Highly Active Antiretroviral Therapy (HAART) in Ethiopia.

Background: Mothers with an undetectable viral load pose no risk of transmitting the Human Immunodeficiency Virus (HIV) to their fetuses. However, there is limited information on the HIV viral suppression status (≤ 1000 RNA copies/mL) among pregnant mothers at the national level. This study aimed to assess the HIV viral load suppression status among pregnant women and identify factors associated with unsuppressed maternal viral levels (> 1000 RNA copies/mL).

Methods: We conducted a cross-sectional study using secondary data from the national HIV viral load data repository. The study included all pregnant women who initiated antiretroviral therapy (ART) and underwent routine HIV viral load testing. Data were collected from July 2022 to June 2023 (2015 Ethiopian Fiscal Year (EFY)). Analysis was performed using STATA v.17, with descriptive statistics (frequency, percentage, mean, and standard deviation) calculated. A mixed-effects logistic regression model was used to quantify the strength of associations between variables and HIV viral load status (suppressed vs. unsuppressed), expressed through odds ratios.Variables showing a significant association with the outcome (p < 0.02) were selected for further analysis using multiple logistic regression models.

Results: The analysis included a total of 13,000 mothers with complete data from viral load tests conducted on pregnant women. The HIV viral suppression rate among these women before delivery was 96.8%. Among those with suppressed results, 96.5% had an undetectable HIV viral load. Multiple binary logistic regression analysis indicated that individuals aged 19-29 had 3.17 times higher odds (AOR 3.17, 95% CI 1.17-5.17, p = 0.002) of having an unsuppressed viral load compared to those under 19. Additionally, individuals with poor adherence to treatment had 12.6 times higher odds of experiencing unsuppressed viral loads (AOR 12.64, 95% CI 10.74-14.54, p = 0.001). However, no significant association was found between the timing of viral load testing and unsuppressed maternal HIV viral load.

Conclusion: The findings indicate that while the overall rates of HIV viral suppression among pregnant women are high, specific demographic factors such as age and treatment adherence play crucial roles in achieving undetectable viral loads. The data suggests a need for targeted interventions focusing on mothers age from 19 to 30 years and strategies to improve adherence to treatment regimens to enhance outcomes further.The results have significant implications for policy and clinical practices aimed at improving health outcomes for mothers and newborns affected by HIV/AIDS.