A Multi-Component, Peer-Led Intervention for Pregnant and Post-Partum Women with HIV Improves Viral Suppression Over Time in Rural Uganda

Achieving viral suppression among pregnant and breastfeeding women with HIV is essential to promoting their health and eliminating vertical transmission of HIV. We hypothesized that a multi-component and peer-led intervention would increase viral suppression among pregnant and breastfeeding women with HIV in rural Southwestern Uganda. The ENHANCED-SPS intervention included the development of a counseling protocol, point-of-care viral load testing, and standardized support delivered by peer-mothers. Among 505 pregnant and post-partum women receiving the ENHANCED-SPS intervention (2019-2021), we evaluated the change in viral suppression (HIV RNA< 1000 c/mL) from baseline to 12 months of follow-up with targeted minimum loss-based estimation (TMLE), accounting for clustering and missing outcomes. The proportion with viral suppression was 70.0% (95%CI: 65.9-74.1%) at baseline and 94.9% (95%CI: 92.5-97.4%) at 12 months, corresponding to a 24.9% (95%CI: 21.6-28.2%; p<0.001) absolute increase over time. Significant improvements over time were observed across age groups (15-24 years, 25-34 years, and 35+ years) and for both pregnant and post-partum women. Approximately 95% of women in all age groups and pregnant women achieved viral suppression at 12-months. However, post-partum women lagged behind with only 75.7% viral suppression at 12-months, despite a 58.9% (95%CI: 27.4-90.3%) increase from baseline. The multi-component, peer-led ENHANCED-SPS intervention resulted in meaningful improvements in viral suppression for pregnant and breastfeeding women with HIV; however, additional support is needed during the post-partum period.