Assessment of unsuppressed viral load and its determinants among pregnant and breastfeeding women living with HIV in the prevention of vertical transmission programme in Bugesera District, Rwanda, 2023

Abstract Background Prevention of vertical transmission (PVT) of HIV programs are designed to prevent the transmission of HIV during pregnancy and breastfeeding. Nevertheless, attaining viral suppression among mothers living with HIV remains a major challenge, especially in resource-constrained settings like Bugesera District, Rwanda. This study aim to determine the prevalence and determinants of unsuppressed viral load (VL) among pregnant and breastfeeding women living with HIV enrolled in the PVT of HIV program as of 2023. Methods An analytical cross-sectional study using retrospective record review was carried out using secondary data from 508 pregnant and breastfeeding women living with HIV enrolled in the PVT of HIV services in 15 health centres in Bugesera District between January 2023 and December 2023, Data were extracted from patient records and analysed using descriptive statistics, bivariate analysis, and multivariate logistic regression to identify factors associated with an unsuppressed VL (≥ 200 copies/mL). Results Among the 508 pregnant and breastfeeding women living with HIV enrolled in the PVT of HIV services, the prevalence of unsuppressed VL was 8.5% (95% CI: 6.3–11.2). factors associated with unsuppressed VL were mental health problems (adjusted odds ratio [aOR] = 4.7, 95% CI: 2.3–9.5, p < 0.001), low attendance to antenatal care (ANC) (< 4 visits) (aOR = 2.2, 95% CI: 1.1–4.7, p = 0.025), a history of treatment interruption (aOR = 2.4, 95% CI: 1.1–4.9, p = 0.015) and being married or cohabiting (aOR = 2.0, 95% CI: 1.0–4.1, p = 0.035). Conclusion The unsuppression viral load rate among women living with HIV in Bugesera District was high. This study highlights the need of strengthening psychosocial support, increase attendance of antenatal care consultations and improve antiretroviral (ART) retention in the PVT of HIV program, particularly among women who are partnered.