Factors Associated With Intrapartum Detectable Viral Load Among Hiv Positive Parturients 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 among pregnant women is the strongest predictor. Knowledge of factors associated with DVL could inform integrated prevention services both in prenatal and postnatal care.

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.

Materials and methods A cross-sectional study conducted among 140 HIV infected expectant women attending RMBH. Maternal sociodemographic and clinical characteristics were collected using structured interviewer administered questionnaire and viral load assay was done by the AMPATH Reference Laboratory with a detection threshold of 40 copies/ml. Descriptive statistics of means and proportions as well as bivariate tests of associations (p ≤ 0.05) were conducted, followed by logistic regression for statistically significant variable.

Results 99 (70.9%) of the participants knew their HIV status prior to the pregnancy under review, 34 (24.3%) sero-discordant and 77 (55.0%) presented late (> 16weeks) for their first antenatal visit. TDF/3TC/EFV was the most common antiretroviral therapy (ART) regimen with an overall median ART duration of 20 (IQR: 6.0, 60.0) months. 25 (17.9%) had DVL, of whom 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). Those with moderate or severe ART side effects were significantly more likely to have a detectable viral load at delivery (AOR = 6.189; 95% CI: 1.330, 28.797; p = 0.020).

Conclusion The prevalence of DVL was 17.9% with moderate or severe ART related side effects being significant predictors. Adherence counselling in integrated PMTCT and antenatal care should focus on the recognition of ART-related side effects and their management.