The peripartum viral load cascade and outcomes of infants exposed to HIV in Lesotho.

OBJECTIVES

This study describes the peripartum viral load (VL) monitoring cascade among individuals initiating antiretroviral therapy (ART) before delivery, as well as HIV testing, prophylaxis and outcomes of their infants in routine care in Lesotho, southern Africa.

METHODS

Data from medical charts review of paper-based registers at 20 healthcare facilities in two districts of Lesotho were combined with data from the Viral Load Cohort North-East Lesotho (VICONEL). We included people with HIV who attended their first antenatal care visit at a participating healthcare facility after 31 December 2019, had a delivery date before 1 January 2022 and initiated dolutegravir-based ART before delivery, as well as their infants.

RESULTS

A total of 353 pregnant people with HIV and 357 infants exposed to HIV were recorded. Among 17/353 (5%) with an initial VL ≥1000 copies/mL, a timely (within 4 months) follow-up VL was provided for 4/17 (24%). Among 233/353 (66%) with an initial VL <1000 copies/mL, a timely (within 7 months) follow-up VL was provided for 120/233 (52%). For 103/353 (29%), no VL measurement was available during pregnancy. Overall, peripartum VL monitoring was guideline-adherent for 157/353 (44%) pregnancies. Among infants exposed to HIV, 301/357 (84%), 274/357 (77%) and 172/357 (48%) received guideline-adherent prophylactic ART, early infant HIV testing within 2 months and 9-month HIV testing, respectively. Vertical transmissions occurred in 2/357 (1%) infants.

CONCLUSION

There were substantial gaps in peripartum HIV service delivery or uptake as well as in HIV prevention and testing of infants exposed to HIV.