Abstract
BackgroundHIV prevalence in Mozambique is estimated to be 13.2%. Routine viral load for HIV monitoring was first implemented in the rural area of Tete in 2014. Programmatic data showed an unexpected high proportion of high viral load results, with up to 40% of patients having a viral load above 1000 copies/ml.ObjectivesThis qualitative study aimed to explore perceptions about virological failure and viral load monitoring from the perspective of HIV positive patients on first-line antiretroviral therapy (ART) and health-care workers.MethodsThe study was conducted in seven rural communities in Changara-Marara district, Tete province, Mozambique. A total of 91 participants took part in in-depth interviews (IDIs) and focus group discussions (FGDs), including health-care workers (n = 18), patients on ART in individual care or Community Adherence Groups (CAGs) who experienced virological failure and virological re-suppression (n = 39) and CAG focal points (n = 34). Purposive sampling was used to select participants. Interviews and FGDs were conducted in Nhuengue and Portuguese. IDIs and FGDs were translated and transcribed before being coded and thematically analysed.ResultsEmergent themes showed that patients and health-care workers attributed great importance to viral load monitoring. A supressed viral load was viewed by participants as a predictor of good health and good adherence. However, some patients were confused and appeared distressed when confronted with virological failure. Viral load results were often little understood, especially when virological failure was detected despite good adherence. Inadequate explanations of causes of virological failure, delayed follow-up viral load results, repeated blood tests and lack of access to second-line ART resulted in reduced confidence in the effectiveness of ART, challenged the patient-provider relationship and disempowered patients and providers.ConclusionIn this rural context undetectable viral load is recognized as a predictor of good health by people living with HIV and health-care workers. However, a lack of knowledge and health system barriers caused different responses in patients and health-care workers. Adapted counselling strategies, accelerated viral load follow-up and second-line ART initiation in patients with virological failure need to be prioritized.
Highlights
HIV still represents a major public health challenge
Viral load results were often little understood, especially when virological failure was detected despite good adherence
Inadequate explanations of causes of virological failure, delayed follow-up viral load results, repeated blood tests and lack of access to second-line Antiretroviral Therapy (ART) resulted in reduced confidence in the effectiveness of ART, challenged the patient-provider relationship and disempowered patients and providers
Summary
HIV still represents a major public health challenge. Unprecedented efforts, including decentralization of HIV services to primary health care level, have increased access to Antiretroviral Therapy (ART) [1]. Of the 19 million People Living with HIV (PLWH) in the East and Southern African region, 10 million are on ART [2]. Poor adherence may result in Acquired Drug Resistance (ADR), and may hamper the effects of increased access to ART. The HIV prevalence amongst adults in Mozambique (15–49 years old) is 13.2% [3]. Medecins Sans Frontières (MSF) has supported the Ministry of Health in providing HIV care in the central province of Tete since 2001. HIV prevalence in Mozambique is estimated to be 13.2%. Routine viral load for HIV monitoring was first implemented in the rural area of Tete in 2014. Programmatic data showed an unexpected high proportion of high viral load results, with up to 40% of patients having a viral load above 1000 copies/ml
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