Page 391 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 4 of 8 Original Research

100000 16
14

10000 12
10
Measurements 1000 Frequency 8 6

100 4
2
0
10 10 12 14 16 18 20 22 24 26 28 30 32
Baseline VL Follow-up VL Knowledge Score
Viral load
FIGURE 2: Distribution of knowledge scores among 82 participants. The
VL, viral load. maximum obtainable score is 32.
FIGURE 1: Evolution of viral load in 15 participants who were viraemic at the
initial visit over the subsequent 4 weeks. The lower, middle and upper red lines
represent viral load measurements of 50, 400 and 1000 copies/mL, respectively. importance or relevance. We found knowledge to be generally
good, with a median score of 23 of a possible 32 points
TABLE 2: Outcome of pregnancy in the study cohort. (IQR 19–26, range 10–32) (Figure 2). The most poorly
Variable All No Transient Persistent answered questions dealt with condom use, specifically the
(n = 82) viraemia (n = 67) viraemia (n = 7) viraemia (n = 8) appropriate response to condoms breaking, negotiation of
Live 62 49 6 7
Infant PCR positive 0 0 0 0 condom use when planning to conceive, responding to
Infant PCR negative 62 49 6 7 missed treatment doses, the relevance of VL monitoring and
Spontaneous abortion 4 4 0 0 the development of antiretroviral drug resistance. We found
Stillbirth 1 1 0 0 a positive correlation of knowledge score with VAS score
Outcome unknown 15 13 1 1 (r = 0.36, p = 0.0009). Patients with full VAS compliance
scored higher than those with partial compliance (median 24
TABLE 3: Correlation between self-reported adherence on initial visual analogue [IQR 21–26] vs. 20 [IQR 18–23], p = 0.002). We found no
scale and viraemic status. correlation between knowledge score in the viraemic group
Adherence Persistent Transient No
viraemia viraemia viraemia (median score 22 [IQR 19.3–24.7]) versus the fully suppressed
n % n % n % group (median score 23 [IQR 21–25], p = 0.36).
Full (100%) 3 37.5 3 50.0 46 69.7
Partial (< 100%) 5 62.5 3 50.0 20 30.3 We aggregated a number of questions in our questionnaire to
Not reported 0 - 1 - 1 - produce four indicators of social deprivation. Thirty-seven
(45.1%) involuntarily slept with more than three persons in a
persistent viraemia (50%) reported submaximal follow-up room, nine (11.0%) had involuntarily gone without food for
VAS scores, while all six patients of the transient viraemia two or more days in the preceding six months, 18 (22.0%) had
group (100%) scored themselves at 100. Pill counts proved not completed secondary school and 46 (59.1%) were
unreliable, given that only 15 participants (18.3%) consistently currently unemployed. Only 13 (15.9%) of our sample had
brought their pills for counting. However, viraemic patients not experienced any of these challenges, and most participants
reported more missed doses in the preceding month than did had experienced multiple challenges (Table 4). However,
those who were suppressed: the difference approached but none of these indices correlated significantly with either
did not reach statistical significance ( p = 0.08). adherence or viraemia.

We assessed HIV knowledge by asking standardised We found no association between such parameters as
questions on HIV disease, condom use and ART. We scored gestational age, time on ART, previous PMTCT exposure,
each of the 16 questions at 0, 1 or 2 points based on whether prior exposure to other ARV drugs, behavioural factors
the participants showed no understanding, partial including condom use, alcohol use, disclosure and knowledge
understanding or adequate understanding, respectively. We of partner status, and either adherence or viraemia (data not
defined adequate understanding as recognition on the part of shown).
the participant of the importance of the knowledge item in
self-management of HIV infection, as well as insight into the Discussion
reasons for its importance, while no understanding implied We found that 54% of the pregnant women seeking antenatal
either ignorance of the item or a lack of awareness of its care at the study facility were receiving ART. Of women who
significance. Partial understanding was intermediate, with booked on PCART, 18% presented with viraemia, and 47% of
some awareness of the knowledge item but no insight into its the viraemia was transient. Only 28% of pregnancies were

http://www.sajhivmed.org.za 384 Open Access