Background: Postpartum retention of women in HIV care is challenging but critical for achieving HIV epidemic control. We used 2015-16 Malawi population-based HIV Impact Assessment (MPHIA) survey data to describe postpartum viral suppression, as a measure of treatment retention, in HIV positive (HIV+) women.
Methods: Women who provided consent for participation in MPHIA were interviewed and tested for HIV using the national rapid test algorithm; positives were confirmed by Geenius? (Bio-Rad). HIV RNA viral load suppression was defined as < 1,000 copies/mL. Current antiretroviral treatment (ART) use was defined as self-reported or detectable ART in blood. HIV+ women aged 15-49 years who delivered in the 36 months prior to the survey, were included in this analysis. We used weighted percentages to describe current viral suppression by self-reported HIV status and ART use during the most recent pregnancy in the 36 months prior to the survey.
Results: Of the 369 women who tested HIV+ in MPHIA and delivered in the last 36 months, 72.2% (95% confidence intervals (CI): 66.8% - 77.6%) self-reported being HIV+, 19.8% (95% CI: 14.8% - 24.8%) self-reported testing HIV negative (HIV-) and 6.7% (95% CI: 3.9% - 9.5%) self-reported being unaware of their HIV status during pregnancy. Of the 369 HIV+ women, 75.9% (95% CI: 70.5%-81.3%) were virally suppressed (VS).
Among women who self-reported being HIV+, testing HIV- or being unaware of their HIV status during pregnancy, 87.7%, 47.4% and 33.2%, respectively, were VS as measured in MPHIA. Among women who reported being HIV+ during pregnancy, 98.5% (95% CI: 97.1-99.9%) received ART during pregnancy; 95.5% were currently on ART, of whom, 90.8% were VS. Among women who reported testing HIV- during pregnancy, 39.0% were currently on ART, of whom 93.6% were VS. Among women who were unaware of their HIV status during pregnancy, 32.2% were currently on ART, of whom 89.8% were VS (Table).
Conclusions: Viral suppression was high in women who received ART during pregnancy, indicating high retention on treatment. Our results indicate need to strengthen postpartum engagement in care for women who were unaware of their HIV status during pregnancy or were infected postpartum, through regular screening and re-testing.