Longitudinal Analysis of Viral Suppression Before, During, and After Pregnancy Among Women on Antiretroviral Therapy in Uganda: Six-year Real-World Evidence

Introduction: This study evaluated the effectiveness of Antiretroviral Therapy (ART) and associated factors on viral-suppression before, during, and after pregnancy (maternal timeline). Methods We conducted a cohort study, retrospectively reviewing records of 1,291 pregnant women on ART. Descriptive statistics summarised demographics and clinical characteristics. Chi-square, Fisher’s exact, Generalised Estimating Equations and logistic regression assessed variations in viral-suppression across the maternal timeline (p < 0.05). Results ART regimen distribution was: DTG (62.5%), EFV (28.8%), NVP (4.5%), and PI (4.2%). Regimens varied in effectiveness before and after (p = 0.000, p = 0.018) but not during pregnancy. Longitudinal risk of non-suppression was noted for; poor adherence (aIRR = 8.48, CI: 1.82–39.43, p = 0.000) and third line (aIRR = 8.48, CI: 1.82–39.43, p = 0.006). Increased non-suppression odds were observed; before pregnancy, PI regimens (OR: 6.49, CI: 2.55–16.53, p = 0.000), third line (OR: 26.83, CI: 1.64–439.36, p = 0.021), poor adherence (OR: 19.64, CI: 2.70–142.68, p = 0.003). During pregnancy, third line (aOR: 51.75, CI: 1.62–1651.93, p = 0.026), and poor adherence (aOR: 26.84, CI: 1.56–461.08, p = 0.023). After pregnancy, PI regimens (OR: 3.78, CI: 1.35–10.59, p = 0.011), and third line (OR: 21.57, CI: 1.32–351.61, p = 0.03, aOR: 51.75, CI:1.62-1651.93, p = 0.026). Additional predictors included BMI, ART Duration, second line regimen and age. Conclusion ART effectiveness varied before and after but not during pregnancy. PI regimens were linked to non-suppression, while EFV, NVP, and DTG showed similar suppression across maternal timelines. Non-suppression was driven by poor adherence, advanced regimens, ART duration, nutrition, and age, highlighting the need for targeted support.