Abstract
Studies of viral suppression on first-line antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLHIV) in Haiti are limited, particularly among PLHIV outside of the Ouest department, where the capital Port-au-Prince is located. This study described the prevalence and risk factors for delayed viral suppression among PLHIV in all geographic departments of Haiti between 2013 and 2017. Individuals who received viral load testing 3 to 12 months after ART initiation were included. Data on demographics and clinical care were obtained from the Haitian Active Longitudinal Tracking of HIV database. Multivariable logistic regression was performed to predict delayed viral suppression, defined as a viral load ≥1000 HIV-1 RNA copies/mL after at least 3 months on ART. Viral load test results were available for 3,368 PLHIV newly-initiated on ART. Prevalence of delayed viral suppression was 40%, which is slightly higher than previous estimates in Haiti. In the multivariable analysis, delayed viral suppression was significantly associated with younger age, receiving of care in the Ouest department, treatment with lamivudine (3TC), zidovudine (AZT), and nevirapine (NVP) combined ART regimen, and CD4 counts below 200 cells/mm3. In conclusion, this study was the first to describe and compare differences in delayed viral suppression among PLHIV by geographic department in Haiti. We identified populations to whom public health interventions, such as more frequent viral load testing, drug resistance testing, and ART adherence counseling should be targeted.
Highlights
Careful adherence to effective antiretroviral therapy (ART) for people living with human immunodeficiency virus (PLHIV) leads to suppression of plasma viral loads to undetectable levels.Delays in viral suppression can lead to virologic failure, formally defined by the World Health Organization (WHO) in developing countries as the failure to achieve a plasma viral load level below 1,000 HIV-1 RNA copies/mL after three months on ART [1]
We assessed whether there were any systematic differences between the characteristics of persons living with human immunodeficiency virus (PLHIV) who had test results reported to the SALVH surveillance system (n = 3,368) vs those who did not have reliable test results reported to SALVH (n = 3,027)
This study was the first to assess factors associated with delayed viral suppression among PLHIV initiating first-line ART outside of Port-au-Prince, Haiti using the national centralized surveillance system
Summary
Careful adherence to effective antiretroviral therapy (ART) for people living with human immunodeficiency virus (PLHIV) leads to suppression of plasma viral loads to undetectable levels.Delays in viral suppression can lead to virologic failure, formally defined by the World Health Organization (WHO) in developing countries as the failure to achieve a plasma viral load level below 1,000 HIV-1 RNA copies/mL after three months on ART [1]. Careful adherence to effective antiretroviral therapy (ART) for people living with human immunodeficiency virus (PLHIV) leads to suppression of plasma viral loads to undetectable levels. Previous studies conducted among clinics located in the capital of Port-au-Prince reported virologic failure prevalence estimates between 32% and 51% [6, 7]. Major drug regimen changes–an indicator of failing drug therapies suggestive of virologic failure–have been assessed in Haiti, with another study reporting positive associations with female sex, younger adult age (20–39 years old), ART initiation year after 2006, and lower CD4 (
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