Abstract
Background: In sub-Saharan Africa where genotypic drug resistance testing is rarely performed and poor adherence is blamed for the inability to achieve viral suppression and treatment failure, programmatic approaches to preventing & handling these are thus essential. Hypothesis tested was antiretroviral therapy adherence effect on viral load outcome. This study was aimed at determining and monitoring HIV/AIDS disease progression using viral load to provide prognostic information and evaluate patients for viral suppression using the World Health Organization (WHO) guideline strategies.
 Methods: This study was an observational study of subjects living with HIV already initiated on antiretroviral therapy for at least six months, enrolled in health facilities across Ondo State, South-Western Nigeria, during a 12-month observation period starting October 2018 till September 2019. Quantitative viral load analysis was done using Polymerase Chain Reaction, Roche Cobas Taqman 96 Analyzer. All data were statistically analyzed, using Statistical Package for the Social Sciences (SPSS), with multiple comparisons done using Post Hoc Bonferonni test. Results: A total of 8124 (1947 males & 6177 females) subjects eligible for the study were recruited. Most of them are in the age range of 35 – 39 years, with a mean age of 42.02 ± 10.88 years. 7162 (88.2%) & 1771 (21.8%) of the subjects had viral suppression of <1000 RNA copies per ml and <20 RNA copies per ml respectively. The unsuppressed subjects went through enhanced adherence counselling (EAC) for three months and viral load test repeated thereafter. 192 patients who had completed the three sessions of EAC and repeated viral load increased the entire suppression numbers to 7339 (90.3%) & 1824 (22.5%) <1000 RNA copies per ml and <20 RNA copies per ml respectively during the period of observation. ART adherence has significant effect on viral load outcome from the study hypothesis tested.
 Conclusion: Current ART regimen & HIV treatment enhanced adherence counseling are key to the achieving viral suppression, thus, routine viral load monitoring will ultimately help in HIV/AIDS disease progression follow up and reduce treatment failure tendencies. This will help more patients stay on first line regimen and prolong their life expectancy, indicating that the UNAIDS last 90 target is achievable.
Highlights
In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is regarded as the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential
This study was an observational study of adult patients living with Human Immunodeficiency Virus (HIV) already initiated on antiretroviral (ARV) therapy for at least six months enrolled at various primary, secondary and tertiary level hospitals across Ondo State in South-Western Nigeria, during a 12-month observation period starting October 2018 to September 2019
The unsuppressed subjects went through enhanced adherence counselling (EAC) for three months and viral load test repeated thereafter. 192 patients who had completed the three sessions of EAC and repeated viral load increased the entire suppression numbers to 7339 (90.3%) & 1824 (22.5%)
Summary
In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is regarded as the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. HIV viral load is a virological marker of antiretroviral treatment (ART) response and HIV/AIDS disease progression used to manage and monitor the infection in patients living with virus. The magnitude of the viral load after ART initiation provides prognostic information about the disease progression. The guidelines of the World Health Organization (WHO) for the treatment of Human Immunodeficiency Virus (HIV) infection recommend that, where possible, the viral load of individuals receiving ART be measured every month to detect viral replication and confirm treatment failure whenever it occurs [4]. According to the WHO’s strategy for the surveillance and monitoring of HIV drug resistance in Low & Middle Income Countries (LMICs), a viral load of
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