Sustained maternal human immunodeficiency virus viral load suppression and cascade of human immunodeficiency virus testing among exposed infants in Rwanda

Table 1 Incidence of sustained viral load suppression, persistent viremia, viral rebound and new suppression among pregnant women living with human immunodeficiency virus in Rwanda

	Sustained viral load suppression		Persistent viremia		Viral rebound		Newly suppressed
	n/N	%	n/N	%	n/N	%	n/N	%
Overall	1830/2010	91.0	27/2010	1.3	73/2010	3.6	80/2010	4.0
Age (years)
13-24	185/199	93.0	4/199	2.0	6/199	3.0	4/199	2.0
25-34	599/661	90.6	8/661	1.2	22/661	3.3	32/661	4.8
35-50	1046/1150	91.0	15/1150	1.3	45/1150	3.9	44/1150	3.8
Marital status
Single	358/412	86.9	8/412	1.9	17/412	4.1	29/412	7.0
Married or living together	1311/1423	92.1	14/1423	1.0	52/1423	3.6	46/1423	3.2
Divorced/widowed	140/53	91.5	5/53	3.3	4/53	2.6	4/53	2.6
Missing	21/22	95.5	0/22	0.0	0/22	0.0	1/22	4.5
Assigned to peer educator
No	1184/1303	90.9	22/1303	1.7	46/1304	3.5	51/1304	3.9
Yes	646/707	91.4	5/707	0.7	27/707	3.8	29/707	4.1
Human immunodeficiency virus status disclosed
No	386/448	86.2	10/448	2.2	20/448	4.5	32/448	7.1
Yes	1444/1562	92.4	17/1562	1.1	53/1562	3.4	48/1562	3.1
Prior exposure to ART
No	627/706	88.8	14/706	2.0	26/706	3.7	39/706	5.5
Yes	1173/1269	92.4	13/1269	1.0	45/1269	3.6	38/1269	3.0
Missing	30/35	85.7	0/35	0.0	2/35	5.7	3/35	8.6
Pregnant at the start of ART
No	514/578	88.9	13/578	2.2	24/578	4.2	27/578	4.7
Yes	1218/1318	92.4	8/1318	0.6	43/1318	3.3	49/1318	3.5
Missing	98/114	86.0	6/114	5.3	6/114	5.3	4/114	2.4
Number of pregnancies since start
0	313/336	93.2	2/336	0.6	10/336	3.0	11/336	3.3
1-2	1312/1452	90.4	22/1452	1.5	56/1452	3.9	62/1452	4.3
≥ 3	205/222	92.3	3/222	1.4	7/222	3.2	7/222	3.2
Place of delivery
Hospital	1704/1869	91.2	25/1869	1.3	68/1829	3.6	72/1829	3.8
Home	38/44	86.4	0/44	0.0	1/44	2.3	5/44	11.4
Missing	88/97	90.7	2/97	2.1	4/97	4.1	3/97	3.1
Type of health care facility
Clinic	24/28	85.7	0/28	0.0	2/28	7.1	2/28	7.1
Health center	1806/1982	91.1	27/1982	1.4	71/1982	3.6	78/1982	3.9
Number of health care workers
1-5	833/925	90.0	13/925	1.4	37/925	4.0	42/925	4.5
6-10	675/745	91.1	11/745	1.5	30/745	4.0	25/745	3.4
≥ 3	318/340	93.5	3/340	0.9	6/340	1.8	13/340	3.8

ART: Anti-retroviral therapy.

Table 2 Factors associated with sustained viral load suppression among pregnant women living with human immunodeficiency virus in Rwanda

Characteristics	Bivariate		Multivariable
	IRR (95%CI)	P value	Adjusted IRR (95%CI)	P value
Age (years)
18-24	Reference
25-34	0.97 (0.92–1.03)	0.354
35-50	0.98 (0.93–1.03)	0.399
Marital status
Single	Reference		Reference
Married or living together	1.06 (1.01–1.12)	0.0201	1.04 (0.99–1.10)	0.106
Divorced/widowed	1.06 (0.98–1.14)	0.140	1.05 (0.97–1.13)	0.206
Assigned to peer educator
No	Reference
Yes	1.01 (0.97–1.04)	0.741
Human immunodeficiency virus status disclosed
No	Reference		Reference
Yes	1.07 (1.02–1.13)	0.0041	1.06 (1.00–1.11)	0.031
Prior exposure to ART
No	Reference		Reference
Yes	1.04 (1.01–1.08)	0.0261	1.01 (0.97–1.06)	0.609
Pregnant at the start of ART
No	Reference		Reference
Yes	1.04 (1.00–1.08)	0.0401	1.03 (0.98–1.08)	0.233
Number of pregnancies since start
0	Reference		Reference
1-2	0.97 (0.93–1.01)	0.176	0.99 (0.95–1.03)	0.630
≥ 3	0.99 (0.94–1.05)	0.854	0.99 (0.94–1.05)	0.881
Type of health care facility
Clinic	Reference
Health center	1.05 (0.86–1.30)	0.605
Number of health care workers
1-5	Reference		Reference
6-10	1.01 (0.97–1.05)	0.596	1.01 (0.97–1.04)	0.761
≥ 11	1.04 (1.00–1.08)	0.080	1.04 (1.00–1.09)	0.062

¹Indicates significant P value.

ART: Anti-retroviral therapy; IRR: incidence rate ratio; Ref: Reference.

Table 3 Human immunodeficiency virus testing cascade among human immunodeficiency virus exposed infants in Rwanda

	n	%
PCR done 6 weeks
Yes	1145	100.0
No	0	0.0
Serology done at 9 months
Yes	1089	95.1
No	56	4.9
Serology done at 18 months
Yes	1006	87.9
No	139	12.1
Tested persistently
Yes	999	87.3
No	146	12.7
Human immunodeficiency virus testing results
Positive	8	0.7
Negative	1137	99.3

Table 4 Maternal and facility characteristics associated with persistent human immunodeficiency virus testing among human immunodeficiency virus exposed infants in Rwanda

Characteristics	Bivariate		Multivariable
	RR (95%CI)	P value	Adjusted RR (95%CI)	P value
Age
18-24	Reference
25-34	1.03 (0.95–1.13)	0.376
35-50	1.04 (0.95–1.13)	0.406
Marital status
Single	Reference
Married or living together	1.02 (0.96–1.08)	0.470
Divorced/widowed	0.97 (0.87–1.08)	0.568
Assigned to peer educator
No	Reference		Reference
Yes	1.05 (1.01–1.10)	0.0231	1.06 (1.01–1.11)	0.0211
Human immunodeficiency virus status disclosed
No	Reference		Reference
Yes	0.96 (0.92–1.01)	0.120	0.97 (0.92–1.02)	0.184
Prior exposure to ART
No	Reference
Yes	0.99 (0.95–1.04)	0.651
Pregnant at the start of ART
No	Reference		Reference
Yes	0.96 (0.92–1.01)	0.103	0.97 (0.93–1.02)	0.225
Number of pregnancies since start
0	Reference
1-2	1.01 (0.95–1.08)	0.747
≥ 3	0.97 (0.88–1.06)	0.507
Place of delivery
Hospital	Reference
Home	0.92 (0.77–1.12)	0.413
Type of health care facility
Clinic	Reference
Health center	1.11 (0.88–1.40)	0.393
Number of health care workers
1-5	Reference		Reference
6-10	0.98 (0.93–1.03)	0.463	0.99 (0.94–1.03)	0.571
≥ 11	1.04 (0.98–1.10)	0.154	1.06 (0.99–1.13)	0.091

¹Indicates significant P value.

ART: Anti-retroviral therapy; RR: Risk ratio; Ref: Reference.

Table 5 Trend in viral load outcomes during pregnancy and postpartum period among women living with human immunodeficiency virus from different parts of the world

Ref.	Country	Study year	Outcome and definition	Percentages of outcome
				Time 1	Time 2	Time 3
Patel et al[28], 2018	United states	1996-2015	VLS (HIV RNA < 500 copies/mL) measured at start of pregnancy, end or pregnancy and 6 months postpartum	34.8	60.1	42.7
Lyatuu et al[16], 2021	Tanzania	2014-2016	VLS (HIV RNA < 400 copies/mL) measured between 0-11 months and at ≥ 36 months since enrolled at prevention of mother to child transmission	85.1	90.6
Landes et al[29], 2021	Malawi	2014-2016	Detectable viral load (HIV RNA > 40 copies/mL measured at enrollment, 12-months and 24-months post-partum	15.5	9.9	12.0
Boucoiran et al[20], 2017	Canada	1997-2015	Viral rebound HIV RNA > 50 copies/mL or > 400 copies/mL for 1997-1998 enrollees and measured within 1 month before delivery	0.0	6.0
Moyo et al[17], 2021	South Africa	2016-2017	Viraemia (HIV RNA ≥ 50 copies/mL) measured during pregnancy, at delivery and 24-months post-partum	53.6	36.9	33.5
Ntlantsana et al[18], 2019	South Africa	2016-2017	Viraemia (HIV RNA ≥ 50 copies/mL) measured at 4 weeks post enrollment among pregnant women those who were viremic at enrollment	100	53.3
Meade et al[21], 2018	United States	2011-2016	VLS (HIV RNA < 200 copies/mL) measured at delivery, 12-months and 24-months postpartum	59.0	15.0	0.0
Zanré et al[22], 2024	Canada	2012-2020	Undetectable VL (< 50 copies/mL), measured at delivery and 2-18 weeks postpartum	94.0	87.0
Jiang et al[31], 2024	Kenya	2015-2017	Viral load suppressed (HIV RNA < 1000 copies/mL) measure within the past 6-months and 24-months postpartum	100	83.8
Myer et al[23], 2017	South Africa	2013-2014	VLS (HIV RNA < 50 copies/mL). measured at enrollment and 12-months postpartum	100	70.0
Adams et al[19], 2015	United states	2005-2011	VLS (HIV RNA < 200 copies/mL). measured at 12-months and 24-months postpartum	31.0	34.0
Moyo et al[30], 2021	South Africa	2018-2020	Viral load un-suppression (HIV RNA > 1000 copies/mL). measured during pregnancy, delivery and up to 9-months postpartum	18.0	20.6	14.8
Flynn et al[24], 2021	Multiple countries	2011-2014	VLS (HIV RNA < 1000 copies/mL) measured at 6-weeks, 14-weeks, 26-weeks, and 50-weeks postpartum. Here we present 6-weeks, 14-weeks and 26-weeks data	91.0	89.0	88.0
Hatcher et al[25], 2022	South Africa	2013-2017	VLS (HIV RNA < 50 copies/mL) measured at 6-months, and 12-months postpartum	84.0	67.0
Brittain et al[26], 2020	South Africa	2013-2014	Viral load ≥ 50 copies/mL at delivery and 12-months postpartum among women who were diagnosed with HIV during pregnancy	21.0	32.0
Ngarina et al[27], 2015	Tanzania	2004-2006	Viral load ≥ 400 copies/mL measured at enrollment, 3-months, 6-months, 12-months and 24-months postpartum. Here we present proportion of VL ≥ 400 at enrollment, 6-months and 12-months postpartum	97.0	22.0	61.0

Multiple countries included India, Malawi, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. HIV: Human immunodeficiency virus; VL: Viral loads; VLS: Viral load suppression.