Abstract
Background The World Health Organization currently encourages enhanced adherence counseling for human immunodeficiency virus (HIV) seropositive people with a high viral load count before a treatment switch to the second-line regimen, yet little is known about viral load suppression after the outcome of enhanced adherence counseling. Therefore, this study aimed to assess viral suppression after enhanced adherence counseling sessions and its predictors among high viral load HIV seropositive people. Methods Institutional-based retrospective cohort study was conducted among 235 randomly selected HIV seropositive people who were on ART and had a high viral load (>1000 copies/ml) from June 2016 to January 2019. The proportion of viral load suppression after enhanced adherence counseling was determined. Time to completion of counseling sessions and time to second viral load tests were estimated by the Kaplan–Meier curve. Log binomial regression was used to identify predictors of viral re-suppression after enhanced adherence counseling sessions. Result The overall viral load suppression after enhanced adherence counseling was 66.4% (60.0–72.4). The median time to start adherence counseling session after high viral load detected date was 8 weeks (IQR 4–8 weeks), and the median time to complete the counseling session was 13 weeks (IQR 8–25 weeks). The probability of viral load suppression was higher among females (ARR = 1.2, 95% CI: 1.02–1.19) and higher educational status (ARR = 1.7, 95% CI: 1.25–2.16). The probability of viral load suppression was lower among people who had 36–59 months duration on ART (ARR = 0.35, 95% CI: 0.130–0.9491) and people who had > 10,000 baseline viral load count (ARR = 0.44, 95% CI: 0.28–0.71). Conclusion This study showed that viral suppression after enhanced adherence counseling was near to the WHO target (70%) but highlights gaps in time to enrolment into counseling session, timely completion of counseling session, and repeat viral load testing after completing the session.
Highlights
In the mid-2017, 20.9 million people living with human immunodeficiency virus (HIV) were taking antiretroviral therapy (ART) globally [1] and monitoring of people on ART is crucial to ascertain successful treatment, identify adherence challenges, and determine whether ART regimens should be switched in cases of treatment failure [2]. e World Health Organization (WHO) recommended the use of viral load testing as the gold standard to monitor the patient’s responses to ART [2].e three 90s (90-90-90) strategy which was developed by UNAIDS clearly states that 90% of all people on ART should have a suppressed viral load [3].Initial viral load testing in people with HIV should be after 6 months of initiating ART and every 12 months thereafter routinely
In the mid-2017, 20.9 million people living with HIV were taking antiretroviral therapy (ART) globally [1] and monitoring of people on ART is crucial to ascertain successful treatment, identify adherence challenges, and determine whether ART regimens should be switched in cases of treatment failure [2]. e World Health Organization (WHO) recommended the use of viral load testing as the gold standard to monitor the patient’s responses to ART [2]
Targeted viral load testing was acquired immunodeficiency syndrome (AIDS) Research and Treatment offered for suspected clinical or immunological failure [4]. e result of a viral load test could be unsuppressed, which implies that HIV is not controlled by the current ART regimen
Summary
In the mid-2017, 20.9 million people living with HIV were taking antiretroviral therapy (ART) globally [1] and monitoring of people on ART is crucial to ascertain successful treatment, identify adherence challenges, and determine whether ART regimens should be switched in cases of treatment failure [2]. e World Health Organization (WHO) recommended the use of viral load testing as the gold standard to monitor the patient’s responses to ART [2].e three 90s (90-90-90) strategy which was developed by UNAIDS clearly states that 90% of all people on ART should have a suppressed viral load [3].Initial viral load testing in people with HIV should be after 6 months of initiating ART and every 12 months thereafter routinely. E three 90s (90-90-90) strategy which was developed by UNAIDS clearly states that 90% of all people on ART should have a suppressed viral load [3]. Since poor adherence is the most common reason for treatment failure [6,7,8], the WHO recommends enhanced adherence counseling sessions for 3–6 months for people with high viral load count before diagnosing first-line treatment failure. Enhanced adherence counseling (EAC) is a continual and repeated process that involves a structured assessment of the current level of adherence, explore the specific barriers the patient must overcome, assisting patients to identify solutions, and address barriers and develop an individualized adherence interventional plan which improve viral load suppression and reduces subsequent treatment failure [9]
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