The respondents’ mean age was 30.78 years (n=319) with a standard deviation (SD) of ±6.56 years.
Their age ranged from 18 to 50 years; 77.4 % of them were ≤ 35 years
In Table1 out of 319 respondents that completed information about their marital status, 233(73.0) respondents reported that they were married and 24(7.5%) were divorced/Separated
In table1, Orthodox and Protestants had the highest proportion of 48.6 and 45.8% and ethnicity the majority 246(77.1%) were Oromo followed by Amhara 46(14.4%).
Of the respondents, 116(36.4%) were not attained formal education and 18(5.6) achieved were diploma and above (see table 1)
Clinical Characteristics of respondents
Clinical characteristics included time to ART from HIV diagnosis, the WHO clinical stage at ART start, CD4 count at ART, time on ART, missed appointments, missed doses in the past month, adherence to ART, type of ART regimen and counseling sessions. These are exhibited in Table 2.
Out of 319 respondents that had WHO stage at ART start documented, 35.7% (n=114) were staged as WHO stage 1 and 45.6% (n=146) as stage 2. The results of the respondents’ WHO clinical stage at ART start is exhibited in table 1. Out of the 319 respondents, 196 had their CD4 counts at ART start as exhibited in table one had less than (≤ 350 cells/µL were 61.4% at baseline and 85.3% respondents (n= 271) had > 350 cells/µL during data collection on current recent CD4 counts.
The mean CD4 at ART start was 349.68 cells/µL and IQR (1- 1012). Out of the 319 respondents that had current CD4 count > 350 cells/µL 272(85.3%) while initiated ART with CD4 cell counts ≤ 350 cells/µL were 61.4%.
The majority of the respondents were initiated on the recommended ART regimen for option B+ with 65% (n=207) TDF+3TC+EFV.
Other respondents were initiated on AZT+3TC+EFV 3.8 % (n=12). None of the respondents were initiated on 2nd line regimen.
Time to ART from HIV test
In the study, all the 319 (100%) respondents were assessed for time to ART following HIV testing. The mean time in months among the 31.7% (n=101) women that delayed (did not start on the same day) initiating ART following an HIV test. The results of the respondents’ time to ART start following HIV testing are exhibited in figure 1
Viral suppression
The study results produced an evidence of a mean VL (copies/ml) of 197.27 copies/ml.
The study results indicate that majority of the respondents 89.7% were suppressed of which 80.3% were undetectable (VL= 0 copies /ml3. When dichotomized, 89.7% (n=286) HIV pregnant women were suppressed with VL <1000 copies/ml versus 10.3% (n=33) that were not suppressed (VL >1000 copies/ml).
Respondents that were on ART for a shorter period ≤37 months had the least proportion of women 31% were suppressed with VL<1000 copies/ml compared to those on ART for >38 months (58.7%) were suppressed.
CD4 count response
The median (IQR) CD4 count change or difference among women that had initial and last CD4 was 581 cells/μl and mean CD4 count 629.17ceels/ml3. Out of the total 319 respondents that were assessed for CD4 response, more than 85.3% had increase CD4 count. Among the women that had decreased or no change in CD4, only five individual had no CD4 count change (difference between the initial and last CD4 count was zero).
Predictors of viral suppression at multivariable level
Variables that had p value <0.2 as well as the primary independent variable (WHO clinical stage 2 95% CI; 0.316 to 2.036, p=0.008) compared to WHO stage 1; women that missed doses in the past month 95% CI; 0.047-1.077, p=0.033) versus those that did not miss; women that missed an appointment 95% CI; 0.002 - 0.280, p=0.047), at ART start CD4 95% CI 2.6 to 8.23 , P= 0.021, maternal months on ART, 38- 70 months (P=0.037), >71 months (p=0.032) and adherence( p=0.0306 ) were associated with viral suppression with p values >0.05.
Out of 319 respondents included in the final model (p<0.05), factors that were independently associated with increased HIV viral load copies/ml included women that poor /fair adherence to ART drugs compared to those that good (coef. -1.390, 95% CI; -2.059 to -0.721, p<0.001). For each additional increase in time to ART from HIV testing in months, HIV VL copies/ml increased by 0.018 copies/ml (95% Confidence interval (CI) 0.002 to 0.035, p=0.03). Therefore, in this study, missing doses in the past month, missing appointments, baseline CD4 and maternal months on ART were statistically significant.
Predictors of CD4 count response at multivariate level
Out of 319 respondents included in the final model (p=0.001), increased gestational age at ART start, maternal age in years and adherence on medication were independently associated with CD4 response or immunological outcomes among HIV pregnant women initiated on lifelong ART on option B+. Improved CD4 response was associated with increased gestational age at ART start (coef. 106.508, 95% CI; 25.238 to 186.472, p =0.011). Alternatively, decreasing CD4 count was associated with increased age (coef. -11.156, 95% CI; -21.183 to -1.128, p=0.029) and fair/poor adherence to medication (coef. -121.931, 95% CI; -227.86 to -16.001, p= 0.024). Variables that were not independently associated with CD4 response included time to ART following HIV testing, missed doses in the past month and parity.