Linkage to intensive adherence counselling among HIV-positive persons on ART with detectable viral load in Gomba district, rural Uganda

Rita Nakalega,Ronald Makanga Kakumba,Nelson Mukiza,Samuel Kizito,Andrew Mujugira,Juliet Allen Babirye,Catherine Nakaye,George Kiwanuka,Robert Menge,Cynthia Ndikuno Kuteesa,Hellen Kaganzi,Zubair Lukyamuzi,Irene-Kinera Kagimu,Henry Debem

doi:10.1186/s12981-021-00349-9

Abstract

BackgroundAntiretroviral therapy (ART) adherence is a primary determinant of sustained viral suppression, HIV transmission risk, disease progression and death. The World Health Organization recommends that adherence support interventions be provided to people on ART, but implementation is suboptimal. We evaluated linkage to intensive adherence counselling (IAC) for persons on ART with detectable viral load (VL).MethodsBetween January and December 2017, we conducted a retrospective chart review of HIV-positive persons on ART with detectable VL (> 1000 copies/ml), in Gomba district, rural Uganda. We abstracted records from eight HIV clinics; seven health center III’s (facilities which provide basic preventive and curative care and are headed by clinical officers) and a health center IV (mini-hospital headed by a medical doctor). Linkage to IAC was defined as provision of IAC to ART clients with detectable VL within three months of receipt of results at the health facility. Descriptive statistics and multivariable logistic regression analyses were used to evaluate factors associated with linkage to IAC.ResultsOf 4,100 HIV-positive persons on ART for at least 6 months, 411 (10%) had detectable VL. The median age was 32 years (interquartile range [IQR] 13–43) and 52% were female. The median duration on ART was 3.2 years (IQR 1.8–4.8). A total of 311 ART clients (81%) were linked to IAC. Receipt of ART at a Health Center level IV was associated with a two-fold higher odds of IAC linkage compared with Health Center level III (adjusted odds ratio [aOR] 1.78; 95% CI 1.00–3.16; p = 0.01). Age, gender, marital status and ART duration were not related to IAC linkage.ConclusionsLinkage to IAC was high among persons with detectable VL in rural Uganda, with greater odds of linkage at a higher-level health facility. Strategies to optimize IAC linkage at lower-level health facilities for persons with suboptimal ART adherence are needed.

Highlights

Antiretroviral therapy (ART) adherence is a modifiable determinant of viral suppression and long-term treatment success i.e., viral load (VL) suppression below the lower limit of detection of commercially available assays [1,2,3,4]
Linkage to inten‐ sive adherence counselling (IAC) Three hundred and thirty one participants (81%) with non-suppressed viraemia were linked to the IAC intervention within three months of receipt of viral load test results
Linkage was similar among participants who had been on ART for more than 5 years and those on ART for 6–11.9 months (89% vs. 76%; p = 0.07)

Summary

Introduction

Antiretroviral therapy (ART) adherence is a modifiable determinant of viral suppression and long-term treatment success i.e., viral load (VL) suppression below the lower limit of detection of commercially available assays [1,2,3,4]. Nakalega et al AIDS Res Ther (2021) 18:15 sub-therapeutic drug levels and are three times as likely to rapidly progress to virologic failure compared with those who adhere to ART [5, 6]. Antiretroviral therapy (ART) adherence is a primary determinant of sustained viral suppression, HIV transmission risk, disease progression and death. We evaluated linkage to inten‐ sive adherence counselling (IAC) for persons on ART with detectable viral load (VL)

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