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. 2025 Jul;29(7):2066-2076.
doi: 10.1007/s10461-025-04639-5. Epub 2025 Feb 3.

Socio-ecological Determinants of Detectable Viremia among Pregnant People Living with HIV in South Brazil: The Role of Stimulant Use Disorder and Homelessness

Christopher Justin Hernandez  1 , Fernando Echegaray  2 , Kavya Sundar  3 , Lanbo Z Yang  4 , Mary Catherine Cambou  5 , Eddy R Segura  6 , Marineide Gonçalves de Melo  7 , Breno Riegel Santos  7 , Ivana Rosângela Dos Santos Varella  8 , Karin Nielsen-Saines  9
Affiliations

Socio-ecological Determinants of Detectable Viremia among Pregnant People Living with HIV in South Brazil: The Role of Stimulant Use Disorder and Homelessness

Christopher Justin Hernandez et al. AIDS Behav. 2025 Jul.

Abstract

Pregnant patients living with HIV are a priority group for the recruitment into the HIV healthcare cascade to prevent adverse maternal and neonatal health outcomes. Understanding the structural, interpersonal, and individual factors that are associated with detectable HIV viremia is of importance to guide outreach and intervention priorities. This was a retrospective cohort study of pregnant patients living with HIV who delivered from January 1, 2017, to December 31, 2023, at a tertiary-level hospital and referral institution for HIV care in Porto Alegre, Brazil. The socio-ecological model was used to guide hypothesis testing regarding associations with detectable viremia. In total, 549 patients were included, of whom 110 (20%) were found to have detectable viremia. Significant differences between detectable and undetectable viremia included prenatal care, homelessness, having a sero-different partner, and stimulant use. Multivariable associations included prenatal care (adjusted Risk Ratio [aRR] = 0.20, 95% Confidence Interval [95% CI] = 0.15-0.26), homelessness (aRR = 4.02, 95% CI = 2.74-0.26), stimulant use disorder (aRR = 3.30, 95% CI = 2.23-4.87), crack use (aRR = 2.82, 95% CI = 1.85-4.29), and cocaine use (aRR = 1.89, 95% CI = 1.17-3.06). Intervention research should focus on housing and mental health services, and how to mitigate their impact on HIV healthcare. Intervention research is greatly needed as current tools may not be sufficient to tackle the issue of stimulant use disorder and its effects on ART adherence.

Keywords: HIV; Homelessness; Pregnancy; Socio-ecological factors; Stimulant use; Viral suppression.

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Conflict of interest statement

Declarations. Ethics Approval: This study was approved by the institutional review board (protocol number 14.124) of Hospital Conceição, Porto Alegre, Brazil. Competing Interests: The authors have declared no competing interests or conflicts to declare.

Figures

Fig. 1
Fig. 1
Hypothesized socio-ecological associations with detectable viremia among pregnant people living with HIV. Note, the associated factors do not cover the spectrum of factors associated with structural, social, and individual determinants of health
See this image and copyright information in PMC

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References

    1. CDC, Treating HIV, November HIV. 12, 2024. Accessed December 23, 2024. https://www.cdc.gov/hiv/treatment/index.html
    1. Viral Load – International Association of Providers of AIDS Care. Accessed December 23. 2024. https://www.iapac.org/fact-sheet/viral-load/
    1. Pathela P, Jamison K, Braunstein SL, et al. Initiating antiretroviral treatment for newly diagnosed HIV patients in sexual health clinics greatly improves timeliness of viral suppression. AIDS. 2021;35(11):1805–12. - PubMed
    1. INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, Emery S, Grund B, Sharma S, Avihingsanon A, Cooper DA, Fätkenheuer G, Llibre JM, Molina JM, Munderi P, Schechter M, Wood R, Klingman KL, Collins S, Lane HC, Phillips AN, Neaton JD. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807. - PMC - PubMed
    1. Eisinger RW, Dieffenbach CW, Fauci AS. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable. JAMA. 2019;321(5):451–2. - PubMed

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