A multicomponent, peer-led intervention for pregnant and postpartum women with HIV improves viral suppression over time in rural Uganda

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Achieving viral suppression among pregnant and breastfeeding women with HIV is essential to promoting their health and eliminating vertical transmission of HIV. We hypothesized that a multicomponent and peer-led intervention would increase viral suppression among pregnant and breastfeeding women with HIV in the rural Southwestern Uganda. The ENHANCED-SPS intervention included the development of a counseling protocol, point-of-care viral load testing, and standardized support delivered by peer-mothers. Among 505 pregnant and postpartum women receiving the ENHANCED-SPS intervention (2019-2021), we evaluated the change in viral suppression (HIV RNA < 1000 c/mL) from baseline to 12 months of follow-up with targeted minimum loss-based estimation, accounting for clustering and missing outcomes. The proportion with viral suppression was 70.0% (95% CI: 65.9, 74.1%) at baseline and 94.9% (95% CI: 92.5, 97.4%) at 12 months, corresponding to a 24.9% (95% CI: 21.6, 28.2%; P < 0.001) absolute increase over time. Significant improvements over time were observed across age groups (15-24 years, 25-34 years, and 35+ years) and for both pregnant and postpartum women. Approximately 95% of women in all age groups and pregnant women achieved viral suppression at 12 months. However, postpartum women lagged behind with only 75.7% viral suppression at 12 months, despite a 58.9% (95% CI: 27.4, 90.3%) increase from baseline. The multicomponent, peer-led ENHANCED-SPS intervention resulted in meaningful improvements in viral suppression for pregnant and breastfeeding women with HIV; however, additional support is needed during the postpartum period.