Viral suppression in models of care for improving engagement of antiretroviral therapy in postpartum women living with HIV

OBJECTIVE: To compare viral suppression between two models of care [adherence club and integrated maternal and child healthcare (MCH)] for improving engagement of postpartum women with HIV (WWH) to antiretroviral therapy (ART). DESIGN: Individual participant data network meta-analysis (IPD-NMA) of two randomized controlled trials in Cape Town, South Africa [Postpartum Adherence Clubs for Antiretroviral Therapy (PACART) comparing adherence clubs to standard of care (primary healthcare ART clinics, SOC), and MCH-ART comparing integrated MCH for the duration of breastfeeding to SOC]. METHODS: One-step IPD-NMA using generalized linear mixed effects models was performed to indirectly compare viral suppression (viral load<50 copies/ml) between adherence clubs and integrated MCH at 6 and 12 months postpartum, linked by SOC as a comparator. RESULTS: Overall, 882 women were included: 471 enrolled in MCH-ART and 411 in PACART. In MCH-ART, 87 and 79% of women in intervention arm had viral suppression at 6 and 12 months postpartum, compared to 70 and 54% in SOC. In PACART, 87 and 74% of women had viral suppression at 6 and 12 months in intervention arm, compared to 79 and 67% in SOC. Adjusting for age, parity, socioeconomic status, tuberculosis (TB) history, HIV diagnosis time, ART duration, and viral load less than 400 copies/ml at enrolment, relative odds of viral suppression in integrated MCH versus adherence clubs were 2 [95% confidence interval (CI): 0.88-4.53] at 6 months and 2.89 (CI: 1.42-5.90) at 12 months. CONCLUSION: In this setting, an integrated MCH model for delivering ART postpartum achieved higher levels and more sustained effect on viral suppression compared to adherence clubs, a popular differentiated service delivery (DSD) model for ART.