Nakyanzi Agnes, Naddunga Faith, Bulterys Michelle A, Mujugira Andrew, Wyatt Monique A, Kamusiime Brenda, Nalumansi Alisaati, Kasiita Vicent, Peacock Sue, Celum Connie L, Ware Norma C
Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda.
Department of Global Health, University of Washington, Seattle, WA 98109, USA.
Diagnostics (Basel). 2023 Dec 28;14(1):72. doi: 10.3390/diagnostics14010072.
High adherence to antiretroviral therapy (ART) is critical for achieving viral suppression and preventing onward HIV transmission. ART continuation can be challenging for pregnant women living with HIV (PWLHIV), which has critical implications for risk of vertical HIV transmission. Point-of-care viral load (POC VL) testing has been associated with improved treatment and retention outcomes. We sought to explore acceptability of POC VL testing among Ugandan PWLHIV during pregnancy and postpartum.
This multimethod analysis drew on quantitative and qualitative data collected between February and December 2021. Quantitatively, we used an intent-to-treat analysis to assess whether randomization to clinic-based POC VL testing during pregnancy and infant testing at delivery was associated with improved viral suppression (≤50 copies/mL) by 3 months postpartum compared to standard-of-care (SOC) VL testing through a central laboratory, adjusting for factorial randomization for the male partner testing strategy. Additionally, a subset of 22 PWLHIV in the POC VL arm participated in in-depth qualitative interviews. We inductively analyzed transcripts to develop categories representing concepts that characterized women's perceptions of POC VL testing during pregnancy and at delivery and ways that POC VL testing may have impacted their ART adherence and viral suppression. Key themes around women's perceptions of POC VL testing were then organized into main categories.
Overall, 151 PWLHIV were enrolled into the study, 77 (51%) of whom were randomized to receive POC VL testing during pregnancy and at delivery. Women reported in qualitative interviews that POC VL testing had (1) motivated their ART adherence during pregnancy and postpartum and that they felt this testing method had (2) helped them protect their infants from acquiring HIV and (3) improved their emotional wellbeing.
POC VL testing was highly acceptable among Ugandan PWLHIV and was viewed as an important tool that women believed improved their ART adherence, gave them information necessary to protect their infants from vertical HIV acquisition, and improved their emotional wellbeing. These findings support the global scale-up of POC VL testing in settings with high HIV burden, especially for PWLHIV who may be at risk of treatment disruptions or loss to follow-up.
坚持高效抗逆转录病毒治疗（ART）对于实现病毒抑制和预防HIV进一步传播至关重要。对于感染HIV的孕妇（PWLHIV）而言，继续接受ART治疗可能具有挑战性，这对垂直传播HIV的风险具有关键影响。即时检测病毒载量（POC VL）与改善治疗及留存结局相关。我们试图探讨乌干达感染HIV的孕妇在孕期及产后对POC VL检测的接受度。
本多方法分析采用了2021年2月至12月期间收集的定量和定性数据。在定量方面，我们采用意向性分析，以评估与通过中心实验室进行的标准护理（SOC）病毒载量检测相比，孕期随机分配接受基于诊所的POC VL检测以及分娩时进行婴儿检测是否与产后3个月时病毒抑制情况改善（≤50拷贝/毫升）相关，并针对男性伴侣检测策略的析因随机化进行调整。此外，POC VL组中的22名感染HIV的孕妇参与了深入的定性访谈。我们对访谈记录进行归纳分析，以形成代表概念的类别，这些概念描述了女性在孕期和分娩时对POC VL检测的认知，以及POC VL检测可能影响她们ART依从性和病毒抑制的方式。围绕女性对POC VL检测认知的关键主题随后被组织成主要类别。
总体而言，151名感染HIV的孕妇被纳入研究，其中77名（51%）被随机分配在孕期和分娩时接受POC VL检测。女性在定性访谈中报告称，POC VL检测（1）在孕期和产后促使她们坚持接受ART治疗，并且她们认为这种检测方法（2）帮助她们保护婴儿免受HIV感染，以及（3）改善了她们的情绪健康。
POC VL检测在乌干达感染HIV的孕妇中具有很高的接受度，并且被视为一种重要工具，女性认为它改善了她们的ART依从性，为她们提供了保护婴儿免受垂直感染HIV所需的信息，并改善了她们的情绪健康。这些发现支持在HIV负担较高的地区扩大POC VL检测的全球推广，特别是对于可能有治疗中断或失访风险的感染HIV的孕妇。
