Baseline Data on Viral Suppression, Treatment Adherence and Mental Health in Peripartum Girls and Young Women With HIV in Zimbabwe.

INTRODUCTION

Peripartum adolescent girls and young women (AGYW) with HIV have lower viral suppression compared to older women. But the recently introduced dolutegravir-based regimens and psychosocial peer motivation may improve viral control. We assessed viral suppression, adherence, drug exposure and mental health in a cohort of peripartum AGYW with HIV.

METHODS

We present baseline data from an ongoing randomized controlled and observational cohort study. Peripartum (conception to 24 months postpartum) AGYW 15- to 24-year-old with HIV and >3 months on tenofovir-based antiretroviral therapy were enrolled between September 2024 and July 2025. Point-of-care viral load and urine tenofovir assays were performed at entry, as well as data on sociodemographic, HIV, treatment and mental health characteristics. Anxiety was assessed using the Generalized Anxiety Disorder-7, depression using the Patient Health Questionnaire-9, stigma using the Modified HIV Stigma Scale and post-traumatic stress disorder using the Primary Care Post Traumatic Stress Disorder 5 tools.

RESULTS

We enrolled 151 participants. Mean age was 21.1 years. All participants were receiving tenofovir, lamivudine and dolutegravir. Baseline mean viral load was 1133 copies/mL (cpm); 135 (89.4%) were virally suppressed (viral load <40 cpm). Mean self-reported adherence over the past 1 month was 97.5%. Tenofovir was detected in 141 (93.4%) participants at baseline. The following were significantly associated baseline with viral suppression (mean [SD]; 95% CI) or (n [%]): higher self-reported adherence (99.5 [1.7]; 99.2-99.8, p<0.001), detectable urine tenofovir (133 [94.3]; p<0.001), being married (79 [92.9]; p = 0.03), having food security (86 [95.6]; p = 0.004) and being financially secure (74 [96.1]; p = 0.02). Seven (4.6%) experienced post-traumatic stress disorder, 132 (88.0%) had minimal or no depression; 137 (92.0%) had minimal anxiety and 81 (53.6%) experienced moderate stigma. Participants without detectable tenofovir in urine were 0.05 times less likely to have baseline viral suppression, adjusted odds ratio (95% CI) (0.05 [0.006-0.4]; p = 0.004). Participants with higher self-reported adherence were 1.3 times more likely to have viral suppression (1.3 [1.1-1.6]; p = 0.008).

CONCLUSIONS

We found high viral suppression at enrolment into a cohort study in peripartum AGYW with HIV. Viral suppression was strongly associated with positive urine tenofovir assays and higher self-reported adherence. High mental wellness was demonstrated.