Abstract
BackgroundThe East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district.MethodsWe reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January – December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established independently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical significance level using STATA version 15.ResultsWe reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The majority of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC.ConclusionDespite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC.
Highlights
The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV)
Study profile Between January – December 2019, a total of 354 people living with HIV (PLHIV) were reported to be virally unsuppressed at the three health facilities of whom 316 were enrolled on intensive adherence counselling (IAC)
Barriers to antiretroviral therapy (ART) adherence associated with viral suppression after IAC In Table 4, we show the findings of the cross-tabulation of barriers reported during IAC and viral suppression after IAC
Summary
The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV). The globally consolidated efforts aim to ensure by that by 2030, 95% of all people living with HIV (PLHIV) that are receiving antiretroviral therapy (ART) have a suppressed viral load [2]. The World Health Organization (WHO) through the “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection” recommends the use of intensive adherence counselling (IAC) as the best strategy to achieve viral suppression [12]. By providing IAC, health workers support clients to improve ART adherence and viral suppression. While there was a near-universal adoption of these guidelines as national country policies [14], the quality of IAC received by patients was unclear and could partly contribute to the increasing viral suppression gap [3]. A high viral load increases the chance of transmission of HIV, increasing the incidence of infection, the burden on health resources, among other concerns [11, 17]
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