Study shows most women who start HIV treatment while pregnant continue taking it for years

Research that tracked women for years after they started antiretroviral treatment (ART) during pregnancy found most were adhering to it, and the majority of them and their children were in excellent health.

What is the research about?

The long-term impact of ART among women with HIV of reproductive age (15–49 years) in East and Southern Africa.

Researchers followed 1,987 women and 2,522 of their children every six months from 2016 onwards (up to a period of five years). The women had begun ART during pregnancy and had already been followed for five years by a separate trial that finished in 2016. They lived in eight locations across Malawi, South Africa, Uganda and Zimbabwe.

Why is this research important?

There is strong evidence that ART can prevent HIV transmission from mother to child.

But there is limited long-term data assessing the effectiveness of ART for both women and their children beyond the first few years of starting treatment. This study provides that long-term data.

What did they find out?

After 36 months (3 years), reported adherence ranged between 73%-97%, depending on location.

After 42 months (3.5 years), 89% of women had an undetectable viral load. This varied on location, from around 82% to 94%.

High proportions of women reported excellent to very good health. This increased over time, from 67% at baseline to 87% at 42 months. The proportion of women who visited a health centre declined from around 15% to 3% over the same period.

The death rate for women was 2·4 per 1000 person-years and 3·4 per 1000 person-years for children (0–9 years). Among the children who died, only one had HIV. These death rates are lower than general death rates in these settings.

The overall pregnancy rate was 17.6 per 100 women-years, which is similar to women without HIV in these settings. Most women gave birth to healthy babies. HIV transmission from mother to child was low, with only three transmission cases reported. This was mostly due to poor ART adherence.

The desire to have more children was low across all sites, except for Kampala. In Soweto and Uganda, there were relatively high levels of abortions and miscarriages.

What does this mean for HIV services?

The findings confirm that women with HIV are willing to continue taking ART for years after being introduced to treatment during pregnancy care. It also confirms the long-term health benefits of ART for women of reproductive age. And that many women are willing to participate in long-term research.

The high rates of adherence may reflect the effect of regular and consistent counselling from researchers. This shows how important it is to provide regular adherence support to women – and all people – with HIV, who need to be on lifelong treatment.

But around one in ten women still had detectable viral load during their last study visit. This suggests some women may need enhanced adherence support, above and beyond 6-monthly care visits. This support should be designed with input from women with HIV and provided in ways that fits into their lives.

The fact that the pregnancy rate was similar to the general pregnancy rate shows how important it is to provide reproductive health services for women with HIV. Sexual and reproductive health (SRH) services should be integrated into HIV services for women to meet their needs and to provide services in one convenient place. In Uganda and Soweto, miscarriages and abortions were higher than average, this also suggests the need to improve HIV and SRH service integration.