{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T04:03:50Z","timestamp":1776139430522,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T00:00:00Z","timestamp":1630713600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T00:00:00Z","timestamp":1630713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Viral load (VL) testing is key in monitoring adherence to antiretroviral therapy (ART) and documenting HIV treatment response. As per HIV treatment guidelines in Uganda, the first VL test is recommended 6\u00a0months after initiation of ART. Undetectable VL (uVL) at ART initiation may be helpful in detecting elite controllers in the absence of previous ART use. We investigated viral suppression at ART initiation among a cohort of HIV-positive pregnant women enrolled in the Friends for Life Circles (FLC) for Option B+ randomized controlled trial (RCT).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Pregnant women\u2009\u2265\u200918\u00a0years of age testing positive for HIV at their first antenatal care visit and starting on ART Option B+ as per the National PMTCT Program guidelines were enrolled into the FLC for Option B+ RCT in urban Kampala and rural Mityana districts of Uganda. Each participant had whole blood samples collected at enrolment to assess baseline VL. Plasma HIV-1 RNA was quantified using COBAS Ampliprep \/COBAS Taqman. Baseline VL below 400 RNA copies\/ml was considered as viral suppression while baseline VL below 20 RNA copies\/ml was considered uVL.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The mean duration from the date of ART initiation to time of sample collection for baseline VL assessment was 4.4\u00a0days (SD 3.6). Of the 532 HIV-positive pregnant women enrolled in the FLC for Option B+ study and newly starting Option B+ without a self-reported history of prior ART use, 29 (5.5%) had uVL and 113 (21.4%) had suppressed VL at baseline. There was no association between participants\u2019 age, gravidity, marital status, mean monthly income, educational level, disclosure of HIV status to partner, and uVL or viral suppression at baseline. However, non-disclosure of HIV status to any other person was associated with decreased odds of viral suppression at baseline (OR 0.640; 0.416\u20130.982).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Twenty-one percent of HIV-positive Ugandan pregnant women initiating ART (Option B+) showed virological suppression at baseline and were presumed to be \u201celite controllers\u201d or to have misreported being ART-naive. Further studies are needed to better understand the biologic mechanisms of elite controllers among pregnant women as well as to differentiate elite controllers from concealed ART use.<\/jats:p>\n                <jats:p><jats:italic>Trial Registration<\/jats:italic>\u00a0The trial was registered as NCT02515370 (04\/08\/2015) on Clinicaltrials.gov.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06608-4","type":"journal-article","created":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T07:02:42Z","timestamp":1630738962000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prevalence of undetectable and suppressed viral load in HIV-infected pregnant women initiating Option B+\u2009in Uganda: an observational study nested within a randomized controlled trial"],"prefix":"10.1186","volume":"21","clinical-trial-number":[{"clinical-trial-number":"nct02515370","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Grace","family":"Gabagaya","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordon","family":"Rukundo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Amone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscilla","family":"Wavamunno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce","family":"Namale-Matovu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Lubega","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemensia","family":"Nakabiito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zikulah","family":"Namukwaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Nolan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel S.","family":"Malamba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"King","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaco","family":"Homsy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Glenn","family":"Fowler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippa","family":"Musoke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,4]]},"reference":[{"key":"6608_CR1","unstructured":"WHO. WHO | Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach- second edition [Internet]. WHO. World Health Organization; 2016. https:\/\/www.who.int\/hiv\/pub\/arv\/arv-2016\/en\/. accessed 22 May 2019."},{"key":"6608_CR2","unstructured":"Unaids. The need for routine viral load testing [Internet]. 2016 [cited 2019 May 15]. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/JC2845_en.pdf"},{"key":"6608_CR3","unstructured":"Friends for Life Circles for Option B Plus - Full Text View - ClinicalTrials.gov [Internet]. [cited 2021 May 24]. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02515370"},{"issue":"3","key":"6608_CR4","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1097\/QAI.0b013e3181bc08f5","volume":"52","author":"O Laeyendecker","year":"2009","unstructured":"Laeyendecker O, Redd AD, Lutalo T, Gray RH, Wawer M, Ssempijja V, et al. Frequency of long-term nonprogressors in HIV-1 seroconverters From Rakai Uganda. J Acquir Immune Defic Syndr. 2009;52(3):316\u20139.","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"3","key":"6608_CR5","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1097\/QAI.0000000000001825","volume":"79","author":"A Kayongo","year":"2018","unstructured":"Kayongo A, Gonzalo-Gil E, G\u00fcm\u00fc\u015fg\u00f6z E, Niwaha AJ, Semitala F, Kalyesubula R, et al. Brief report: identification of elite and viremic controllers from a large urban HIV Ambulatory Center in Kampala. Uganda J Acquir Immune Defic Syndr. 2018;79(3):394\u20138.","journal-title":"Uganda. J Acquir Immune Defic Syndr"},{"issue":"1","key":"6608_CR6","doi-asserted-by":"publisher","first-page":"e86719","DOI":"10.1371\/journal.pone.0086719","volume":"9","author":"AD Olson","year":"2014","unstructured":"Olson AD, Meyer L, Prins M, Thiebaut R, Gurdasani D, Guiguet M, et al. An evaluation of HIV elite controller definitions within a large seroconverter cohort collaboration Okulicz JF. PLoS ONE. 2014;9(1):e86719.","journal-title":"PLoS ONE"},{"issue":"01","key":"6608_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4172\/2155-6113.1000139","volume":"03","author":"F Okulicz","year":"2012","unstructured":"Okulicz F, Elite J. Controllers and long-term nonprogressors: models for HIV vaccine development? J AIDS Clin Res. 2012;03(01):1.","journal-title":"J AIDS Clin Res"},{"issue":"5","key":"6608_CR8","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1080\/15284336.2018.1531534","volume":"19","author":"MV Sivay","year":"2018","unstructured":"Sivay MV, Fogel JM, Wang J, Zhang Y, Piwowar-Manning E, Clarke W, et al. Natural control of HIV infection in young women in South Africa: HPTN 068. HIV Clin Trials. 2018;19(5):202\u20138.","journal-title":"HIV Clin Trials"},{"key":"6608_CR9","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s12978-017-0367-5","volume":"14","author":"R Naigino","year":"2017","unstructured":"Naigino R, Makumbi F, Mukose A, et al. HIV status disclosure and associated outcomes among pregnant women enrolled in antiretroviral therapy in Uganda: a mixed methods study. Reprod Health. 2017;14:107. https:\/\/doi.org\/10.1186\/s12978-017-0367-5.","journal-title":"Reprod Health"},{"key":"6608_CR10","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1186\/s12889-019-7280-5","volume":"19","author":"EM Masereka","year":"2019","unstructured":"Masereka EM, Ngabirano TD, Osingada CP, et al. Increasing retention of HIV positive pregnant and breastfeeding mothers on option-b plus by upgrading and providing full time HIV services at a lower health facility in rural Uganda. BMC Public Health. 2019;19:950. https:\/\/doi.org\/10.1186\/s12889-019-7280-5.","journal-title":"BMC Public Health"},{"issue":"4","key":"6608_CR11","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1093\/infdis\/jiz145","volume":"220","author":"W Sykes","year":"2019","unstructured":"Sykes W, Van den Berg K, Jacobs G, Jauregui A, Roubinian N, Wiesner L, et al. Discovery of false elite controllers: HIV antibody-positive RNA-negative blood donors found to be on antiretroviral therapy. J Infect Dis. 2019;220(4):643\u20137.","journal-title":"J Infect Dis"},{"issue":"3","key":"6608_CR12","first-page":"1","volume":"32","author":"MK Grabowski","year":"2017","unstructured":"Grabowski MK, Reynolds S, Kagaayi J, Gray R, Clarke W, Chang L, et al. The validity of self-reported antiretroviral use in persons living with HIV. AIDS. 2017;32(3):1.","journal-title":"AIDS"},{"issue":"10","key":"6608_CR13","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1093\/infdis\/jit390","volume":"208","author":"JM Fogel","year":"2013","unstructured":"Fogel JM, Wang L, Parsons TL, Ou S-S, Piwowar-Manning E, Chen Y, et al. Undisclosed antiretroviral drug use in a multinational clinical trial (HIV Prevention Trials Network 052). J Infect Dis. 2013;208(10):1624\u20138.","journal-title":"J Infect Dis"},{"issue":"12","key":"6608_CR14","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1086\/518284","volume":"44","author":"European Collaborative Study","year":"2007","unstructured":"European Collaborative Study. Time to undetectable viral load after highly active antiretroviral therapy initiation among hiv-infected pregnant women. Clin Infect Dis. 2007;44(12):1647\u201356.","journal-title":"Clin Infect Dis"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06608-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06608-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06608-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T07:02:54Z","timestamp":1630738974000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06608-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,4]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6608"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06608-4","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,4]]},"assertion":[{"value":"15 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All study procedures were conducted in compliance with the relevant national laws and international regulatory requirements. Written informed consent was obtained from all study participants prior to any protocol-specified procedures being conducted. The study protocol, informed consent forms, and other study instruments administered to participants were reviewed and approved by the Joint Clinical Research Centre (JCRC) Institutional Review Board in Uganda; the Uganda National Council for Science and Technology (UNCST), Johns Hopkins University (JHU) and University of California San Francisco (UCSF) Ethics committees prior to participant enrolment or study procedures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"907"}}