Prevalence and factors associated with intrapartum detectable viral load among pregnant HIV positive women delivering at Riley Mother and Baby Hospital, Eldoret, Kenya.

Abstract

Background: Vertical transmission of Human Immuno-deficiency Virus (HIV), can occur during pregnancy, labour, and delivery, or in breastfeeding. Detectable viral load (DVL) is it’s the strongest predictor. Although several factors have been associated with DVL at delivery, there are few local studies conducted across sub-Saharan Africa countries including Kenya where there is universal Antiretroviral therapy (ART) for all HIV-infected pregnant women. Knowledge of this will inform strategies aimed at eliminating mother to child transmission through the integrated Prevention of Mother to Child Transmission (PMTCT)-Antenatal Care (ANC) Services. Objective: To describe the patient characteristics, determine the prevalence of detectable viral load and assess factors associated with it among HIV infected women delivering at Riley Mother and Baby Hospital (RMBH), Eldoret Kenya. Methods: A cross-sectional study conducted at RMBH in Eldoret Kenya among eligible HIV infected expectant women admitted for delivery. They were enrolled consecutively until the desired sample size of 140 was achieved. Maternal sociodemographic and clinical characteristics were collected using structured interviewer administered questionnaire and viral load assay was done by the AMPATH Reference Laboratory at a detection threshold of 40 copies/ml. Descriptive statistics of means and proportions as well as bivariate tests of associations were conducted using statistical package for social sciences (SPSS) version 24. A p-value of ≤0.05 was statistically significant. Logistic regression was conducted on factors that were statistically significant at the bivariate level. Results: Out of the 140 enrolled HIV positive pregnant women delivering at RMBH, 99 (70.7%) women knew their HIV status before pregnancy. The sero-discordance rate was 24.3% (34/140), while partner disclosure was reported in 111 (79.3%) women. 77 (55.0%) presented late (>16weeks) for their first antenatal visit, while 13 (9.3%) had Syphilis/HIV co-infection. The most common ART regimen was TDF/3TC/EFV. The median duration of antiretroviral therapy was 20 (IQR: 6.0, 60.0) months and moderate or severe ART side effects were reported in 10 (7.1%). Viral load was detectable in 25 (17.9%) of the participants and of these, 5/25 (20%) had Low level viremia (50-1000 copies/ ml) while 17/25 (68%), had > 1000 copies/ml. 16/17 (94%) of those with viral load of >1000copies/ml delivered by spontaneous Vertex Delivery (SVD). When a multivariate analysis was conducted, there was a statistically significant relationship between reporting of moderate or severe ART side effects and having a detectable viral load at delivery (AOR=6.189; 95% CI: 1.330, 28.797; p=0.020). Conclusions: The prevalence of detectable viral load at delivery was 17.9% with 94% of those with >1000 copies/ml delivering through SVD. The significant predictor of intrapartum of detectable viral load was reporting of moderate or severe ART related side effects. Recommendations: Adherence counselling in integrated PMTCT and antenatal care should focus on the recognition of ART-related side effects and their management. There is need to institute mechanisms for checking viral load ahead of delivery.