The risk of mother-to-child transmission of HIV (MTCT) reduces with sustained pre & postpartum administration of suppressive maternal ARVs. The MoMent study evaluated for maternal viral suppression & its correlates among HIV+ Nigerian women.
This prospective cohort study compared structured Mentor Mother (MM) vs unstructured peer support (PS) for PMTCT outcomes. Pregnant women were recruited at 20 matched Primary Healthcare Centers in rural North-Central Nigeria. Structured PS included daily MM supervision, standardized documentation, client tracking, & MM performance evaluations. Maternal viral load (VL) was performed at 6 months postpartum; women lost to followup were tracked back for VL tests. Viral suppression was defined as VL <20 copies/mL. All participants were on ART for ≥6 months. Multivariate logistic regression with generalized estimating equations was used to account for clusters and for adjusting confounders.
Among 497 enrolees, 296 (59.6%) presented for VL; 273/296 (92.2%) had samples collected. Of the 238/273 (87.2%) with available results, 138 (58%) were suppressed. Correlates of suppression were structured MM support (aOR 4.9, CI 2.6 to 9.2); age >30 years (aOR 2.3, CI 1.0 to 4.9); ≥secondary education (aOR 2.0, CI 1.2 to 3.3); Christian religion (aOR 1.4, CI 1.1 to 2.1); PI-based ART (aOR 4.6, CI 1.3 to 16.0), and retention (aOR 3.7, CI 2.5 to 5.5). Marital/disclosure status & distance from facility were not significant.
Organized PS, older age, education, potent ARVs & retention supported viral suppression in our study. The role of religion is unclear & should be further explored.
Structured PS should be targeted to young & lesser educated women to reduce MTCT risk.
Institute of Human Virology, Udochisom Anaba, MPH, Institute of Human Virology, Nigeria