1. Comparison of guidelines for HIV viral load monitoring among pregnant and breastfeeding women in sub-Saharan Africa.
- Author
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Lesosky, Maia, Raboud, Janet M, Glass, Tracy, Brummel, Sean S, Ciaranello, Andrea L, Currier, Judith S, Essajee, Shaffiq, Havlir, Diane V, Koss, Catherine A, Ogwu, Anthony, Shapiro, Roger L, Abrams, Elaine J, and Myer, Landon
- Subjects
Infectious Diseases ,Prevention ,HIV/AIDS ,Mental Health ,Infection ,Reproductive health and childbirth ,Africa South of the Sahara ,Anti-HIV Agents ,Breast Feeding ,Female ,Fertilization ,HIV Infections ,Humans ,Infectious Disease Transmission ,Vertical ,Monte Carlo Method ,Postpartum Period ,Practice Guidelines as Topic ,Pregnancy ,Pregnancy Complications ,Infectious ,Serologic Tests ,Viral Load ,antiretroviral therapy ,HIV ,mathematical model ,pregnancy ,simulation ,viral load monitoring ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology - Abstract
BackgroundIntensified viral load monitoring for pregnant and breastfeeding women has been proposed to help address concerns around antiretroviral therapy (ART) adherence, viraemia and transmission risk, but there have been no systematic evaluations of existing policies.MethodsWe used an individual Monte Carlo simulation to describe longitudinal ART adherence and viral load from conception until 2 years' postpartum. We applied national and international guidelines for viral load monitoring to the simulated data. We compared guidelines on the percentage of women receiving viral load monitoring and the percentage of women monitored at the time of elevated viral load.ResultsCoverage of viral load monitoring in pregnancy and breastfeeding varied markedly, with between 14% and 100% of women monitored antenatally and 38-98% monitored during breastfeeding. Specific recommendations for testing at either a fixed gestation or a short, fixed period after ART initiation achieved more than 95% testing in pregnancy but this was much lower (14-83%) among guidelines with no special stipulations. By the end of breastfeeding, only a small proportion of simulated episodes of elevated viral load more than 1000 copies/ml were successfully detected by monitoring (range, 20-50%).DiscussionAlthough further research is needed to understand optimal viral load frequency and timing in this population, these results suggest that current policies yield suboptimal detection of elevated viral load in pregnant and breastfeeding women.
- Published
- 2020