Peer-mother counseling improves HIV treatment adherence and status disclosure over time among pregnant and postpartum women in rural Uganda

Abstract Adherence to antiretroviral therapy (ART) and disclosure of HIV status are critical for achieving HIV viral suppression and eliminating perinatal transmission of HIV. The ENHANCED-SPS intervention was designed to address barriers to viral suppression among pregnant and postpartum women with HIV and included standardized support and counseling though phone calls by peer-mothers. Using targeted minimum loss-based estimation (TMLE), we evaluated changes in adherence ($\le$1 dose of ART missed per month) and HIV status disclosure (to anyone and to a spouse or partner) among 505 pregnant and postpartum women with HIV who received the ENHANCED-SPS intervention in rural Uganda (2019-2021). ART adherence was 68% (95% CI, 62-74) at baseline and increased to 93% (95% CI, 81-100) after 12 months, corresponding to a 25% increase (95% CI, 9-40; P = .009). Largest improvements were among participants who were aged 15-24 years, breastfeeding, or without viral suppression at enrollment. At baseline, 80% (95% CI, 69-90) had disclosed their HIV status to anyone—increasing to 94% (95% CI, 89-99) after 12 months and corresponding to a 14% improvement (95% CI, 8-21; P = .003). Similar trends were observed for disclosure to a spouse or partner. Among pregnant and postpartum women with HIV in rural Uganda, the ENHANCED-SPS intervention was associated with meaningful improvements in ART adherence and HIV status disclosure after 1 year.