Food insecurity, drug resistance and non-disclosure are associated with virologic non-suppression among HIV pregnant women on antiretroviral treatment

• DOI: 10.1371/journal.pone.0256249
• Publication Date: 2021-08-18T17:39:33Z
• Authors: Bhavna H. Chohan; Keshet Ronen; Brian Khasimwa; Daniel Matemo; Lusi Osborn; Jennifer A. Unger; Alison L. Drake; Ingrid A. Beck; Lisa M. Frenkel; John Kinuthia; Grace John-Stewart
• Keywords: Economics; Macroeconomics; Health Professions; HIV Infections; FOS: Health sciences; 0302 clinical medicine; Pregnancy; Antiretroviral Therapy, Highly Active; HIV Infection; Viral load; Internal medicine; 2. Zero hunger; Depression (economics); Q; R; Age Factors; Human immunodeficiency virus (HIV); Viral Load; 3. Good health; Infectious Diseases; General Health Professions; Emergency Medicine; RNA, Viral; Medicine; Female; Confidentiality; Research Article; Adult; Anti-HIV Agents; Science; Immunology; Microbiology; Medication Adherence; 03 medical and health sciences; Drug Resistance, Viral; Health Sciences; Humans; Biology; Impact of HIV Infection on Cardiovascular Health; Prevention and Treatment of HIV/AIDS Infection; FOS: Clinical medicine; Social Support; Kenya; Food Insecurity; Young adult; Drug resistance; FOS: Biological sciences; HIV-1; Adolescent Sexual Health and Behavior Patterns

We determined social and behavioral factors associated with virologic non-suppression among pregnant women receiving Option B+ antiretroviral treatment (ART). Baseline data was used from women in Mobile WAChX trial from 6 public maternal child health (MCH) clinics in Kenya. Virologic non-suppression was defined as HIV viral load (VL) ≥1000 copies/ml. Antiretroviral resistance testing was performed using oligonucleotide ligation (OLA) assay. ART adherence information, motivation and behavioral skills were assessed using Lifewindows IMB tool, depression using PHQ-9, and food insecurity with the Household Food Insecurity Access Scale. Correlates of virologic non-suppression were assessed using Poisson regression. Among 470 pregnant women on ART ≥4 months, 57 (12.1%) had virologic non-suppression, of whom 65% had HIV drug resistance mutations. In univariate analyses, risk of virologic non-suppression was associated with moderate-to-severe food insecurity (RR 1.80 [95% CI 1.06–3.05]), and varied significantly by clinic site (range 2%-22%, p <0.001). In contrast, disclosure (RR 0.36 [95% CI 0.17–0.78]) and having higher adherence skills (RR 0.70 [95% CI 0.58–0.85]) were associated with lower risk of virologic non-suppression. In multivariate analysis adjusting for clinic site, disclosure, depression symptoms, adherence behavior skills and food insecurity, disclosure and food insecurity remained associated with virologic non-suppression. Age, side-effects, social support, physical or emotional abuse, and distance were not associated with virologic non-suppression. Prevalence of virologic non-suppression among pregnant women on ART was appreciable and associated with food insecurity, disclosure and frequent drug resistance. HIV VL and resistance monitoring, and tailored counseling addressing food security and disclosure, may improve virologic suppression in pregnancy.