Abstract
BackgroundIn people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) (≥1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (<1000 copies/ml).ObjectiveOur study objectives were to determine the proportion who had a high viral load in those people who underwent viral load testing between 1 August 2016–31 July 2017 at Wilkins Hospital, Harare, Zimbabwe. Of those with high viral load to assess; a) the proportion who enrolled for EAC, the demographic and clinical characteristics associated with enrolment for EAC and, b) the proportion who achieved viral load suppression and demographic, clinical characteristics associated with viral load suppression.DesignRetrospective cohort study using routinely collected programme data. Data was collected from PLHIV who were on ART and had a high viral load from 1 August 2016 to 31 July 2017.ResultsOf 5,573 PLHIV on ART between 1 August 2016 and 31 July 2017, 4787 (85.9%) had undergone VL testing and 646 (13.5%) had high VLs. Of these 646, only 489 (75.7%) were enrolled for EAC, of whom 444 (69%) underwent a repeat VL test at ≥ 3 months with 201 (31.2%) achieving VL suppression. The clinical characteristics that were independently associated with higher probability of VL suppression were: a) undergoing 3 sessions of EAC; b) being on 2nd line ART. Initial VL levels >5,000 copies/ml were associated with lower probability of viral suppression.ConclusionThe routine VL testing levels were high, but there were major programmatic gaps in enrolling PLHIV with high VLs into EAC and achieving VL suppression. The full potential of EAC on achieving viral load suppression has not been achieved in this setting. The reasons for these gaps need to be assessed in future research studies and addressed by suitable changes in policies/practices.
Highlights
Since the beginning of the human immunodeficiency virus (HIV) epidemic in the 1980s, about 35 million people are estimated to have died due to HIV infection and by the end of 2016, an estimated 36.7 million [95% CI: 30.8–42.9 million] people were living with HIV (PLHIV) [1]
In people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) ( 1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (
The clinical characteristics that were independently associated with higher probability of VL suppression were: a) undergoing 3 sessions of EAC; b) being on 2nd line Anti-retroviral therapy (ART)
Summary
Since the beginning of the human immunodeficiency virus (HIV) epidemic in the 1980s, about 35 million people are estimated to have died due to HIV infection and by the end of 2016, an estimated 36.7 million [95% CI: 30.8–42.9 million] people were living with HIV (PLHIV) [1]. In PLHIV, viral load (expressed as HIV RNA copies/mL of blood) is a direct indicator of viral replication. Suppressing viral load in PLHIV to less than 1000 copies/ml of blood ( called ‘viral suppression’) is essential for reducing morbidity, mortality and transmission [3]. Anti-retroviral therapy (ART) suppresses HIV replication and by doing so, it has transformed HIV infection from a deadly disease into a manageable chronic illness [2]. The recent HPTN052 clinical trial has shown that viral suppression due to ART can reduce HIV transmission by up to 96% [4]. In people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) ( 1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (
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