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We aimed to determine the impact of point\u2010of\u2010care (POC) VL and targeted drug resistance mutation (DRM) testing in improving VS among pregnant and postpartum women on antiretroviral therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a pre\/post\u2010intervention prospective cohort study among 820 pregnant women accessing HIV care at five public\u2010sector facilities in western Kenya from 2019 to 2022. The pre\u2010intervention or \u201ccontrol\u201d group consisted of standard\u2010of\u2010care (SOC) centralized VL testing every 6 months and the post\u2010intervention or \u201cintervention\u201d group consisted of a combined strategy of POC VL every 3 months, targeted DRM testing, and clinical management support. The primary outcome was VS (VL \u22641000 copies\/ml) at 6 months postpartum; secondary outcomes included uptake and turnaround times for VL testing and sustained VS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 6 months postpartum, 321\/328 (98%) of participants in the intervention group and 339\/347 (98%) in the control group achieved VS (aRR 1.00, 95% confidence interval [CI] 0.98, 1.02). When assessing VS using a threshold of &lt;40 copies\/ml, VS proportions were lower overall (90\u221291%) but remained similar between groups. Among women with viraemia (VL&gt;1000 copies\/ml) who underwent successful DRM testing in the intervention group, all (46\/46, 100%) had some DRMs and 20 (43%) had major DRMs (of which 80% were nucleos(t)ide reverse transcriptase inhibitor mutations). POC VL testing uptake was high (&gt;89%) throughout pregnancy, delivery, and postpartum periods, with a median turnaround time of 1 day (IQR 1, 4) for POC VL in the intervention group and 7 days (IQR 5, 9) for SOC VL in the control group. Sustained VS throughout follow\u2010up was similar between groups with either POC or SOC VL testing (90\u221291% for &lt;1000 copies\/ml, 62\u201370% for &lt;40 copies\/ml).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our combined strategy markedly decreased turnaround time but did not increase VS rates, which were already very high, or sustained VS among pregnant and postpartum women living with HIV. Further research on how best to utilize POC VL and DRM testing is needed to optimize sustained VS among this population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26182","type":"journal-article","created":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T16:23:16Z","timestamp":1699460596000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Impact of point\u2010of\u2010care HIV viral load and targeted drug resistance mutation testing on viral suppression among Kenyan pregnant and postpartum women: results from a prospective cohort study (Opt4Mamas)"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9893-5856","authenticated-orcid":false,"given":"Rena C.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine University of Washington  Seattle Washington USA"},{"name":"Department of Global Health University of Washington  Seattle Washington 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Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Odhiambo","sequence":"additional","affiliation":[{"name":"Family AIDS Care and Education Services Kenya Medical Research Institute  Kisumu Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boaz","family":"Oyaro","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute\u2010CDC  Kisian Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Kingwara","sequence":"additional","affiliation":[{"name":"National HIV Reference Laboratory Kenya Ministry of Health  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enericah","family":"Karauki","sequence":"additional","affiliation":[{"name":"UWKenya  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashon","family":"Yongo","sequence":"additional","affiliation":[{"name":"UWKenya  Nairobi 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