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Impact of HIV-Status Disclosure on HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy

Brittain, Kirsty MPHa,b; Mellins, Claude A. PhDc; Remien, Robert H. PhDc; Phillips, Tamsin K. MPHa,b; Zerbe, Allison MPHd; Abrams, Elaine J. MDd,e; Myer, Landon MBChB, PhDa,b

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1, 2019 - Volume 81 - Issue 4 - p 379–386
doi: 10.1097/QAI.0000000000002036
Epidemiology
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Background: HIV-status disclosure is widely encouraged by counseling services, in part because it is thought to improve antiretroviral therapy (ART) adherence and thus HIV viral suppression. However, few longitudinal studies have examined the impact of disclosure on HIV viral load (VL) during pregnancy and postpartum.

Methods: We explored these associations among 1187 women living with HIV, enrolled between March 2013 and June 2014 in Cape Town, South Africa.

Results: Among women who tested HIV-positive before pregnancy, we observed no association between disclosure and VL at entry into antenatal care among those already on ART, nor at delivery and 12 months postpartum among those initiating ART. Among women who tested HIV-positive during pregnancy and initiated ART subsequently, disclosure to a male partner was associated with a reduced risk of VL ≥50 copies/mL at delivery (adjusted risk ratio: 0.56; 95% confidence interval: 0.31 to 1.01). After stratification by relationship status, this association was only observed among women who were married and/or cohabiting. In addition, disclosure to ≥1 family/community member was associated with a reduced risk of VL ≥50 copies/mL at 12 months postpartum (adjusted risk ratio: 0.69; 95% confidence interval: 0.48 to 0.97) among newly-diagnosed women.

Conclusions: These findings suggest that the impact of disclosure on VL is modified by 3 factors: (1) timing of HIV diagnosis (before vs. during the pregnancy); (2) relationship to the person(s) to whom women disclose; and (3) in the case of disclosure to a male partner, relationship status. Counseling about disclosure may be most effective if tailored to individual women's circumstances.

aDivision of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa;

bCentre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa;

cHIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY;

dMailman School of Public Health, ICAP at Columbia University, New York, NY; and

eVagelos College of Physicians and Surgeons, Columbia University, New York, NY

Correspondence to: Kirsty Brittain, MPH, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Falmouth Building, University of Cape Town Faculty of Health Sciences, Anzio Road, Observatory, Cape Town, South Africa 7925 (e-mail: kirsty.brittain@uct.ac.za).

Supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), Grant number 1R01HD074558. Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation. K.B. is supported by the South African Medical Research Council under the National Health Scholars Programme. C.A.M. and R.H.R. are supported by a grant from the National Institute of Mental Health (NIMH) to the HIV Center for Clinical and Behavioral Studies (P30-MH45320).

Presented at the 11th International Conference on HIV Treatment and Prevention Adherence; May 9–11, 2016; Fort Lauderdale, FL.

The authors have conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received November 04, 2018

Accepted February 27, 2019

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