Engaging Mentor Mothers in Rapid Return of Viral Load Results to Pregnant and Postpartum Women Living with HIV: An Implementation Pilot Study

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Abstract
In Kenya, the primary driver of perinatal HIV transmission is disengagement from care. Virologic monitoring can reinforce adherence and enable timely intervention, yet results are often delayed. Among pregnant (≥ 27 weeks) and postpartum (≤ 6 months) women in HIV care in Kisumu Kenya, we conducted a pilot study in which Mentor Mothers (peer support) returned viral load results (GeneXpert) after a clinic visit between June-December 2023. We assessed feasibility, acceptability, and factors associated with time from sample collection to results to participants via generalized estimating equations with log-transformed time as the outcome and report geometric mean ratios (GMR). We assessed the potential impact on viremia after 6 months using two control groups (one retrospective, one prospectively enrolled). Among 545 participants (273 pilot,123 prospective and 149 retrospective controls), the median age overall was 30 years (interquartile range [IQR] 26–35) and 40% were pregnant. In the pilot, Mentor Mothers returned 100% of 422 viral load results of which 90% were suppressed. The median time from sample collection to result return was 27.0 h (IQR 23.3–54.6). We observed a trend towards slower times among women with prior viremia (adjusted-GMR 1.22, 95%CI: 0.98–1.52). The odds of subsequent viremia did not differ between pilot and control groups (adjusted-OR 1.30, 95%CI: 0.71–2.38). Mentor Mothers reported this approach was a good use of their time. In conclusion, Mentor Mothers rapidly delivered viral load results though we did not observe an impact on viremia. This approach could complement other strategies to optimize person-centered care for pregnant and postpartum women. Trial registry NCT05845619.
Funding Information
  • National Institute of Mental Health (K01MH119910)

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