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Abstract：
BACKGROUND: High viral load during pregnancy and breastfeeding period is the risk factor for vertical transmission of human immunodeficiency virus (HIV). Currently, Dolutegravir (DTG)-based regimens are recommended to attain adequate viral load suppression (VLS) among women. However, its effect on VLS has not been investigated among women in PMTCT care in Ethiopia.
OBJECTIVE: This study aimed to investigate the rate of viral load non-suppression among women exposed to DTG-based versus Efavirenz (EFV)-based regimens in Ethiopia.
METHODS: An uncontrolled before-and-after study design was conducted among 924 women (462 on EFV-based and 462 on DTG-based regimens) enrolled in PMTCT care from September 2015 to February 2023. The outcome variable was the viral load (VL) non-suppression among women on PMTCT care. A modified Poisson regression model was employed, and the proportion was computed to compare the rate of VL non-suppression in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess viral load non-suppression among women on DTG-based and EFV-based regimens by adjusting for other variables.
RESULTS: The overall rate of non-suppressed VL was 16.2% (95% CI: 14.0-18.8%). Mothers on DTG-based regimens had approximately a 30% (adjusted risk ratio (aRR): 0.70; 95% CI: 0.52-0.94) lesser risk of developing non-suppressed VL than women on EFV-based regimens. Besides, older women were 1.38 times (aRR: 1.38; 95% CI: 1.04-1.83); mothers who did not disclose their HIV status to their partners were 2.54 times (aRR: 2.54; 95% CI: 1.91-3.38); and mothers who had poor or fair adherence to antiretroviral (ARV) drugs were 2.11 times (aRR: 2.11; 95% CI: 1.45-3.07) at higher risk of non-suppressed VL.
CONCLUSIONS: Women on DTG-based regimens had a significantly suppressed VL compared to those on EFV-based regimens. Thus, administering DTG-based first-line ART regimens should be strengthened to achieve global and national targets on VLS.
OBJECTIVE: This study aimed to investigate the rate of viral load non-suppression among women exposed to DTG-based versus Efavirenz (EFV)-based regimens in Ethiopia.
METHODS: An uncontrolled before-and-after study design was conducted among 924 women (462 on EFV-based and 462 on DTG-based regimens) enrolled in PMTCT care from September 2015 to February 2023. The outcome variable was the viral load (VL) non-suppression among women on PMTCT care. A modified Poisson regression model was employed, and the proportion was computed to compare the rate of VL non-suppression in both groups. The risk ratio (RR) with a 95% confidence interval (CI) was calculated to assess viral load non-suppression among women on DTG-based and EFV-based regimens by adjusting for other variables.
RESULTS: The overall rate of non-suppressed VL was 16.2% (95% CI: 14.0-18.8%). Mothers on DTG-based regimens had approximately a 30% (adjusted risk ratio (aRR): 0.70; 95% CI: 0.52-0.94) lesser risk of developing non-suppressed VL than women on EFV-based regimens. Besides, older women were 1.38 times (aRR: 1.38; 95% CI: 1.04-1.83); mothers who did not disclose their HIV status to their partners were 2.54 times (aRR: 2.54; 95% CI: 1.91-3.38); and mothers who had poor or fair adherence to antiretroviral (ARV) drugs were 2.11 times (aRR: 2.11; 95% CI: 1.45-3.07) at higher risk of non-suppressed VL.
CONCLUSIONS: Women on DTG-based regimens had a significantly suppressed VL compared to those on EFV-based regimens. Thus, administering DTG-based first-line ART regimens should be strengthened to achieve global and national targets on VLS.
摘要：
背景：怀孕和母乳喂养期间的高病毒载量是人类免疫缺陷病毒（HIV）垂直传播的危险因素。目前,建议使用基于Dolutegravir（DTG）的方案，以在女性中获得足够的病毒载量抑制（VLS）。然而,其对VLS的影响尚未在埃塞俄比亚PMTCT护理的女性中进行调查.
目的：本研究旨在调查埃塞俄比亚暴露于以DTG为基础的方案与以Efavirenz（EFV）为基础的方案的女性的病毒载量无抑制率。
方法：在2015年9月至2023年2月参加PMTCT护理的924名女性（基于EFV的462名和基于DTG的462名）中进行了不受控制的前后研究设计。结果变量是接受PMTCT护理的女性的病毒载量（VL）未抑制。采用改进的泊松回归模型，并计算该比例以比较两组的VL未抑制率。计算具有95％置信区间（CI）的风险比（RR），以通过调整其他变量来评估基于DTG和基于EFV的方案的女性的病毒载量非抑制。
结果：非抑制VL的总发生率为16.2%（95%CI：14.0-18.8%）。与基于EFV的方案的女性相比，基于DTG的方案的母亲发生非抑制VL的风险约为30％（调整后的风险比（aRR）：0.70；95％CI：0.52-0.94）。此外,老年女性为1.38倍(aRR:1.38;95%CI:1.04-1.83);未向伴侣透露HIV感染状况的母亲为2.54倍(aRR:2.54;95%CI:1.91-3.38);抗逆转录病毒(ARV)药物依从性差或一般的母亲为2.11倍(aRR:2.11;95%CI:1.45-3.07)。
结论：与以EFV为基础的方案相比，以DTG为基础的方案的女性具有显著抑制的VL。因此，应加强基于DTG的一线ART方案的管理，以实现VLS的全球和国家目标。
目的：本研究旨在调查埃塞俄比亚暴露于以DTG为基础的方案与以Efavirenz（EFV）为基础的方案的女性的病毒载量无抑制率。
方法：在2015年9月至2023年2月参加PMTCT护理的924名女性（基于EFV的462名和基于DTG的462名）中进行了不受控制的前后研究设计。结果变量是接受PMTCT护理的女性的病毒载量（VL）未抑制。采用改进的泊松回归模型，并计算该比例以比较两组的VL未抑制率。计算具有95％置信区间（CI）的风险比（RR），以通过调整其他变量来评估基于DTG和基于EFV的方案的女性的病毒载量非抑制。
结果：非抑制VL的总发生率为16.2%（95%CI：14.0-18.8%）。与基于EFV的方案的女性相比，基于DTG的方案的母亲发生非抑制VL的风险约为30％（调整后的风险比（aRR）：0.70；95％CI：0.52-0.94）。此外,老年女性为1.38倍(aRR:1.38;95%CI:1.04-1.83);未向伴侣透露HIV感染状况的母亲为2.54倍(aRR:2.54;95%CI:1.91-3.38);抗逆转录病毒(ARV)药物依从性差或一般的母亲为2.11倍(aRR:2.11;95%CI:1.45-3.07)。
结论：与以EFV为基础的方案相比，以DTG为基础的方案的女性具有显著抑制的VL。因此，应加强基于DTG的一线ART方案的管理，以实现VLS的全球和国家目标。
