Factors associated with viral load suppression in pregnant and postpartum women living with HIV in Rwanda: an open-observational cohort study.

Introduction: Achieving and maintaining HIV viral load suppression (VLS) in pregnant and postpartum women living with HIV (WLWH) is critical for their health and to prevent mother-to-child transmission. However, data on VLS in this population are limited. This study aimed to evaluate the prevalence and factors associated with VLS among pregnant and postpartum WLWH in Rwanda within 12 months of enrolling in antenatal care. Methods: An open observational cohort study was conducted using routine clinical data from 10 Rwandan HIV clinics in Kigali City. Data from WLWH on ART who became pregnant and were referred to PMTCT services between 2012 and 2020 were analyzed. The primary outcomes were the proportion of WLWH achieving VLS (viral load (VL) <1,000 or <200 copies/mL) within 12 months of antenatal registration. Logistic regression models assessed associations of VLS with socio-demographic and clinical characteristics. Results: Among 1,002 WLWH, 532 (53%) had documented VL results. The mean age was 30.4 years, with 60% aged 25-34 years. Most (83.7%) were primigravida, and 67% initiated ART before pregnancy. At antenatal care enrollment, 58% had a CD4 count ≥500 cells/uL. Within 12 months, 92% had VL <1,000 copies/mL and 87% had a VL <200 copies/mL. Advanced HIV disease (WHO stage 3 and 4) and lower CD4 counts were associated with lower odds of VLS. Conclusion: Among those with a recorded VL results, nine out of 10 had a VLS, particularly those without advanced HIV disease. The findings underscore the need for targeted interventions for WLWH with advanced HIV entering antenatal care.