1
|
Nakyanzi A, Naddunga F, Bulterys MA, Mujugira A, Wyatt MA, Kamusiime B, Nalumansi A, Kasiita V, Peacock S, Celum CL, Ware NC. " It Soothes Your Heart": A Multimethod Study Exploring Acceptability of Point-of-Care Viral Load Testing among Ugandan Pregnant and Postpartum Women Living with HIV. Diagnostics (Basel) 2023; 14:72. [PMID: 38201381 PMCID: PMC10795616 DOI: 10.3390/diagnostics14010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND High adherence to antiretroviral therapy (ART) is critical for achieving viral suppression and preventing onward HIV transmission. ART continuation can be challenging for pregnant women living with HIV (PWLHIV), which has critical implications for risk of vertical HIV transmission. Point-of-care viral load (POC VL) testing has been associated with improved treatment and retention outcomes. We sought to explore acceptability of POC VL testing among Ugandan PWLHIV during pregnancy and postpartum. METHODS This multimethod analysis drew on quantitative and qualitative data collected between February and December 2021. Quantitatively, we used an intent-to-treat analysis to assess whether randomization to clinic-based POC VL testing during pregnancy and infant testing at delivery was associated with improved viral suppression (≤50 copies/mL) by 3 months postpartum compared to standard-of-care (SOC) VL testing through a central laboratory, adjusting for factorial randomization for the male partner testing strategy. Additionally, a subset of 22 PWLHIV in the POC VL arm participated in in-depth qualitative interviews. We inductively analyzed transcripts to develop categories representing concepts that characterized women's perceptions of POC VL testing during pregnancy and at delivery and ways that POC VL testing may have impacted their ART adherence and viral suppression. Key themes around women's perceptions of POC VL testing were then organized into main categories. RESULTS Overall, 151 PWLHIV were enrolled into the study, 77 (51%) of whom were randomized to receive POC VL testing during pregnancy and at delivery. Women reported in qualitative interviews that POC VL testing had (1) motivated their ART adherence during pregnancy and postpartum and that they felt this testing method had (2) helped them protect their infants from acquiring HIV and (3) improved their emotional wellbeing. CONCLUSIONS POC VL testing was highly acceptable among Ugandan PWLHIV and was viewed as an important tool that women believed improved their ART adherence, gave them information necessary to protect their infants from vertical HIV acquisition, and improved their emotional wellbeing. These findings support the global scale-up of POC VL testing in settings with high HIV burden, especially for PWLHIV who may be at risk of treatment disruptions or loss to follow-up.
Collapse
Affiliation(s)
- Agnes Nakyanzi
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Faith Naddunga
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Michelle A. Bulterys
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
| | - Andrew Mujugira
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
| | - Monique A. Wyatt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.A.W.); (N.C.W.)
- Harvard Global, Cambridge, MA 02138, USA
| | - Brenda Kamusiime
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Alisaati Nalumansi
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Vicent Kasiita
- Infectious Diseases Institute, Makerere University, Kampala P.O. Box 7072, Uganda; (F.N.); (A.M.); (B.K.); (A.N.); (V.K.)
| | - Sue Peacock
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
| | - Connie L. Celum
- Department of Global Health, University of Washington, Seattle, WA 98109, USA; (M.A.B.); (S.P.); (C.L.C.)
- Departments of Medicine and Epidemiology, University of Washington, Seattle, WA 98109, USA
| | - Norma C. Ware
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (M.A.W.); (N.C.W.)
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| |
Collapse
|