DISCUSSION
MTCT, viral suppression
This longitudinal analysis examined the association between self-reported adherence and maternal viral load suppression in sub-Saharan Africa and India. Our analysis showed that more than three-fourths of women in the mART arm reported high adherence to their antiretrovirals at all postpartum study weeks. Although an adherence to ART of 95% is desirable for viral suppression,The self-reported adherence in the 3 days preceding the study visits by the continuous adherence measure was high in both arms, although again, the mothers in the mART arm reported higher adherence to their infant's NVP than their own mART. This was comparable with a cross-sectional study conducted in South Africa wherein 86% of postnatal women reported complete adherence to the zidovudine medication schedule in the 4 days preceding the visit.With half of all MTCT occurring during breastfeeding, making this a crucial time for viral suppression, ongoing VL monitoring throughout this period is recommended to help minimize postpartum transmission risks.The time-to-event analyses were conducted to see whether self-reported maternal adherence to mART can predict time to first mVL ≥ 400 or ≥1000 copies/mL. We found that missing a dose of mART within the last 4 or 2 weeks because the dichotomized, self-reported adherence variable was not associated with time to first mVL occurrence over 400 or 1000 copies/mL at least 6 weeks after randomization. However, notably, with the continuous adherence measure, we observed an association between self-reported missed mART doses over the last 3 days preceding the study visit with time to first occurrence of mVL ≥ 400 or ≥1000 copies/mL. Our findings suggest that this adherence measure can be used as an interim screening tool in settings where resources limit the frequent VL monitoring. This will allow for rapid assessment of decreased adherence risk and help in providing prompt adherence counselling and interventions.Studies conducted in South Africa and in Cape Town, evaluating self-reported adherence questionnaire and scale in HIV-infected adults, found no correlation between adherence and VL.The self-reported adherence and viral load measures were taken as part of PROMISE research study visits, independent of routine HIV care, with a large sample size using the same standardized process and questionnaire across all study sites. This accounts for the confidence in our data and may have reduced socially desirable response bias.