Evaluation of Antiretroviral Therapy Initiated Among Pregnant Women Under Option B+ by Viral Load and CD4 Count Outcomes in Selected Hospitals of West Shewa Zone, Oromia Region, Ethiopia

Abstract

Background

Antiretroviral therapy (ART) is effective for the elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) infection, reducing infant mortality and ensuring maternal virologic suppression, while pregnant women require test and treat under Option B+ programs. Therefore, the study aimed to assess the evaluation of antiretroviral therapy initiated among pregnant women under Option B+ by viral load and CD4 count outcomes in selected hospitals of West Shewa Zone, Oromia Region, Ethiopia.

Methods

Hospital-based cross-sectional study design was employed to conduct the study at randomly selected hospitals providing Option B+ services with routine viral load assessment by Oromia Regional Laboratory (ORL) from January 2016 to January 2017. Bivariate and multivariable logistic regression analyses were conducted to determine factors affecting the time to ART initiation following an HIV test and logistic regression was used to determine the correlation between time and treatment outcomes.

Results

The viral load suppression (VL <1000 copies/mL) was achieved in 31% and 58.7% of patients who were on ART treatment for ≤37 months and longer than 38 months, respectively. It was identified that the mean viral load and CD4 count were 197.27 and 629.17, respectively, while 85.3% of the clients had their CD4 count increased from the baseline data. The study revealed that level of ART adherence, completion of full doses, compliance on appointments, duration of the ART uptake and baseline CD4 count were independent predictors of viral load suppression for women started on option B+ and continued on lifelong ART. And this study also revealed that gestational age at ART start, maternal age in years and adherence on medication were independently associated with CD4 response among HIV pregnant women initiated for lifelong ART.

Conclusion

The study results demonstrated that for 89.7% of study respondents, viral load was suppressed of which 80.3% were undetectable (VL= 0 copies/ml³ and 85.3% had increased CD4 count). This study determined the factors associated with viral load suppression and CD4 count improvement. Therefore, these factors should be emphatically considered during Option B+ program development and training to ensure CD4 count improvement and viral load suppression achievements.

Keywords:

• antiretroviral therapy
• initiation pregnant women Option B +
• viral load
• CD4 count

Acknowledgments

We are grateful to the Department of Nursing and medical staffs for their constructive comments and continuous encouragement starting from topic selection to the development of this research proposal. We also want to acknowledge Ambo University, College of medicine and health sciences for giving us this opportunity. We are grateful for all Mothers attending Prevention of Mother to Child Transmission in West Shoa Zone Health Facilities, Data collectors and supervisor for their valuable contribution and support. Last not list to West zone Health office.

Abbreviations

ANC, Antenatal care; ART, Antiretroviral therapy; AZT, Zidovudine; DNA, Deoxyribonucleic Acid; EFV, Efavirenz; eMTCT, Elimination of Mother-to-child transmission; HBM, Health Belief Model; HIV, Human immunodeficiency virus; MoH, Ministry of Health; MTCT, Mother-to-child transmission; NVP, Nevirapine; PCR, Polymerase chain reaction; PMTCT, Prevention of Mother-to-child transmission; TDF, TenofovirDisoproxilFumarate; UNAIDS, Joint United Nations Programme on HIV/AIDS; WHO, World Health Organization; 3TC, Lamivudine.

Data Sharing Statement

All data underlying the findings described in this manuscript fully available without restriction and if the article is accepted for publication, the data availability statement will be published as part of the final article. There is no legal and/or ethical organization imposing restriction on this research article. Authors have no special access privileges to the data.

Ethics and Consent Statement

Ethical clearance was obtained from the Ethical review committee of Ambo University CMHS (CMHS-R219/2019). Formal letter of cooperation was written to respective hospitals/health centres. Moreover, prior to commencing the study, a written informed consent was obtained from each respondent before data collection. In addition to this parental written consent was found from a parent of respondent. Confidentiality was maintained by omitting their name, and personal identification of participant was not compelled to the study. The right to refuse was respected and information collected from this research project was kept confidential and the collected information was stored in a file, without the name of the study participant. All participants provided written informed consent, and that this study was conducted in accordance with the Declaration of Helsinki. Consent for publication: Ambo University and Authors agreed for publication in a reputable journal. (Agreement Ref number: CMHS-R219/2019).

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests including financial or funding.