HIV Viral suppression Viral Load suppression following Intensive Adherence counseling AMONG People living on treatment at MILITARY-Managed Health Facilities in Uganda

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.

Download Full-text

Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda

BMC Public Health ◽

10.1186/s12889-018-5964-x ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 18

Author(s):

Esther Nasuuna ◽

Joanita Kigozi ◽

Lillian Babirye ◽

Alex Muganzi ◽

Nelson K. Sewankambo ◽

...

Keyword(s):

Public Health ◽

Children And Adolescents ◽

Viral Suppression ◽

Health Facilities ◽

Public Health Facilities ◽

Adherence Counseling ◽

Hiv Viral Suppression

Download Full-text

ART Adherence, Resistance, and Long-term HIV Viral Suppression in Postpartum Women

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa346 ◽

2020 ◽

Vol 7 (10) ◽

Author(s):

Andrew D Redd ◽

Elton Mukonda ◽

Nai-Chung Hu ◽

Tamsin K Philips ◽

Allison Zerbe ◽

...

Keyword(s):

Viral Load ◽

South African ◽

Viral Suppression ◽

African Women ◽

Load Testing ◽

Resistance Mutations ◽

Hiv Viral Suppression ◽

South African Women ◽

Routine Antenatal Care

Abstract HIV+ South African women who achieved viral suppression during routine antenatal care, but later experienced a viremic episode (viral load >1000 copies/mL), were examined for presence of antiretrovirals and classified as “nonadherers” or “suboptimal adherers.” Women were tested for drug resistance mutations (DRMs) at several time points and underwent viral load testing 36–60 months postpartum. Suboptimal adherers were more likely to have DRM detected during their viremic episode (P = .03) and at a subsequent viremic time point (P = .05). There was no difference in levels of viral suppression 36–60 months later in women with DRM detected vs women who had no evidence of DRM (P = .5).

Download Full-text

A modified HIV continuum of care: A six-year evaluation of a viral load cascade at a hospital-based clinic in Kingston, Jamaica

International Journal of STD & AIDS ◽

10.1177/0956462419839514 ◽

2019 ◽

Vol 30 (8) ◽

pp. 748-755 ◽

Cited By ~ 1

Author(s):

Geoffrey J Barrow ◽

Margaret L Brandeau

Keyword(s):

Viral Load ◽

Statistical Analysis ◽

Viral Suppression ◽

Care Delivery ◽

Continuum Of Care ◽

Hiv Care ◽

Viral Load Suppression ◽

Outcome Indicators ◽

Care Continuum ◽

Hiv Continuum Of Care

To achieve the goal of HIV viral suppression, provision of medication alone is not sufficient. Concomitant frameworks to evaluate HIV care delivery programmes are needed. This study examined the care continuum at a hospital-based HIV clinic in Kingston, Jamaica using a modified HIV continuum of care, with an increased focus on viral load indicators (viral load samples taken, results returned and viral suppression). A statistical analysis of patient flow through the care continuum to identify gaps in programme delivery was performed. Key programmatic areas for process improvement and the utility of this approach for viral load suppression interpretation were identified. Between 2010 and 2015, more than 1600 patients had been registered for care and more than 1000 had accessed antiretroviral therapy at this location. Consistent trends in programme performance were seen from 2010 to 2012. Although declines in the proportion of viral load samples taken and results returned occurred because of laboratory failures in 2013, the trend of increasing numbers and proportions of virally suppressed patients continued. Statistical analysis indicated that improvements in laboratory quality (fraction of viral load samples returned with accurate test results) could increase viral load suppression among patients at the clinic by up to 17%. Refining care delivery processes can significantly improve HIV viral load suppression rates. Expanding monitoring frameworks to include all of the essential processes that affect final outcome indicators can provide valuable insight into trends of outcome indicators and programme performance.

Download Full-text

Potential challenges to sustained viral load suppression in the HIV treatment programme in South Africa: a narrative overview

AIDS Research and Therapy ◽

10.1186/s12981-020-00324-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Pascal O. Bessong ◽

Nontokozo D. Matume ◽

Denis M. Tebit

Keyword(s):

South Africa ◽

Drug Resistance ◽

Viral Load ◽

Viral Suppression ◽

Transmitted Drug Resistance ◽

Pharmacokinetics And Pharmacodynamics ◽

Viral Load Suppression ◽

Sustained Viral Suppression ◽

Concurrent Use ◽

Universal Test And Treat

Abstract Background South Africa, with one of the highest HIV prevalences in the world, introduced the universal test and treat (UTT) programme in September 2016. Barriers to sustained viral suppression may include drug resistance in the pre-treated population, non-adherence, acquired resistance; pharmacokinetics and pharmacodynamics, and concurrent use of alternative treatments. Objective The purpose of this review is to highlight potential challenges to achieving sustained viral load suppression in South Africa (SA), a major expectation of the UTT initiative. Methodology Through the PRISMA approach, published articles from South Africa on transmitted drug resistance; adherence to ARV; host genetic factors in drug pharmacokinetics and pharmacodynamics, and interactions between ARV and herbal medicine were searched and reviewed. Results The level of drug resistance in the pre-treated population in South Africa has increased over the years, although it is heterogeneous across and within Provinces. At least one study has documented a pre-treated population with moderate (> 5%) or high (> 15%) levels of drug resistance in eight of the nine Provinces. The concurrent use of ARV and medicinal herbal preparation is fairly common in SA, and may be impacting negatively on adherence to ARV. Only few studies have investigated the association between the genetically diverse South African population and pharmacokinetics and pharmacodynamics of ARVs. Conclusion The increasing levels of drug resistant viruses in the pre-treated population poses a threat to viral load suppression and the sustainability of first line regimens. Drug resistance surveillance systems to track the emergence of resistant viruses, study the burden of prior exposure to ARV and the parallel use of alternative medicines, with the goal of minimizing resistance development and virologic failure are proposed for all the Provinces of South Africa. Optimal management of the different drivers of drug resistance in the pre-treated population, non-adherence, and acquired drug resistance will be beneficial in ensuring sustained viral suppression in at least 90% of those on treatment, a key component of the 90-90-90 strategy.

Download Full-text

Dolutegravir (DTG) Based Fixed Dose Combination (FDC) of Tenofovir/Lamivudine/Dolutegravir (TLD) and Viral Load Suppression in Children in Port Harcourt, Nigeria

Journal of Scientific Research and Reports ◽

10.9734/jsrr/2020/v26i230224 ◽

2020 ◽

pp. 52-59

Author(s):

Nsirimobu Ichendu Paul ◽

Rosemary Ogochukwu Ugwu

Keyword(s):

Adverse Drug Reaction ◽

Drug Reaction ◽

Viral Load ◽

Social Class ◽

Viral Suppression ◽

Undetectable Viral Load ◽

Fixed Dose ◽

Viral Load Suppression ◽

Port Harcourt ◽

The Mean

Background: Currently, dolutegravir (DTG) based fixed dose combinations (FDC) of tenofovir/ lamivudine/dolutegravir (TLD) and Abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) is now recommended by the World Health Organisation (WHO) as the preferred first-and second line antiretroviral drug necessitating transition of eligible children to TLD. Objective: The objective of this study is to compare the HIV viral suppression rate at baseline and after 6 months of transition to TLD and to determine adverse drug reaction associated with the use of TLD if any. Methods: This was a prospective cross-sectional study carried out among stable children who were on treatment and follow up for HIV disease at the Paediatric HIV clinic of the University of Port Harcourt Teaching Hospital (UPTH). All Children who were eligible for transition to TLD, whose care givers/parents gave a verbal consent and who gave consent or accent were recruited for the study. Information obtained included the sociodemographic characteristics, weight and height, ART regimen at initiation of treatment and when it was commenced, the baseline viral load and viral load 6 months after transition and any adverse drug reaction. Obtained data were analysed. Comparison of categorical variables was done using chi square and Fischer’s exact test while A p-value of < 0.05 was set as statistically significant. Results: A total 106 children aged 9 to 18 years with a mean age of 13.4±2.3 years were recruited for the study. Sixty (56.6%) were males, while 59 (55.5%) were from the lower socioeconomic class. The mean weight was 44.4±11.1 kg while the mean height was 151.3 ± 15.2 cm. At baseline, 48 (45.3%) were virally suppressed (viral load < 1000 copies/ml), however after 6 months, 97 (91.5%) became virally suppressed, the difference in viral suppression rate was statistically significant (X2 =53.77, p= 0.0001). Twenty-five (23.6%) had undetectable viral load (<20 copies/ml) at baseline while 61(57.5%) had undetectable viral load after transition. All those who were virally suppressed at baseline remained so 6 months after transition. Also, 80.6% (29/36) of those with treatment failure became virally suppressed. Only one child developed severe erythematous skin rashes. There was no statistically significant relationship between viral suppression and age, sex and social class (P >0.05). Conclusion: This study has shown that DTG-based FDC is efficacious in the treatment of eligible children and adolescents with HIV/AIDS with significant viral load suppression in all age groups, gender and social class. Adverse drug reaction with the use of DTG-based ART is low. Transition to TLD is therefore advocated in eligible patients.

Download Full-text

Effect and implementation experience of intensive adherence counseling in a public HIV care center in Uganda: a mixed-methods study

BMC Infectious Diseases ◽

10.1186/s12879-021-06862-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zubair Lukyamuzi ◽

Samuel Etajak ◽

Thomas Katairo ◽

David Mukunya ◽

Moses Tetui ◽

...

Keyword(s):

Health Care ◽

Viral Load ◽

Healthcare Workers ◽

Care Center ◽

Hiv Care ◽

Art Adherence ◽

Intervention Period ◽

Viral Load Suppression ◽

Related Factors ◽

Adherence Counseling

Abstract Background Intensive adherence counseling (IAC) is an intervention recommended by the World Health Organization to improve anti-retroviral therapy (ART) adherence among people living with HIV on ART with unsuppressed viral load; and in 2016, the intervention was implemented in Uganda. This study evaluated the effect and experiences of providing IAC in an urban HIV care center in Kampala, Uganda. Methods This was a sequential explanatory mixed-method study that compared viral load suppression during IAC implementation (intervention) to the period before IAC at Kisenyi Health centre IV. Data were abstracted from patient files and viral load register. The effect of IAC on viral load suppression and associated factors were analyzed using modified Poisson regression with robust standard errors. Using in-depth interviews and an inductive analysis approach in Atlas-ti 8. We also explored experiences of providing IAC among healthcare workers. Results A total of 500 records were sampled: 249 (49.8%) in the intervention period and 251 (51.2%) in the pre-intervention period. The mean age was lower during the intervention period 33.1 (± 12.0) than 36.5 (± 13.4) in the pre- intervention period, p = 0.002. More clients were currently on Protease-based regimen in the pre-intervention period 179 (71.3%) than 135 (54.2%) in the intervention period, p ≤ 0.001. In the intervention period, all eligible clients received IAC [249/249 (100.0%)]. Overall, 325 (65.0%) received IAC and of these, 143 (44.1%) achieved viral load suppression compared to 46 (26.3%) who received regular counseling. Receiving IAC significantly increased viral load suppression by 22% (aPR 1.22, 95% CI 1.01–1.47). Clients on Protease-based regimen were less likely to suppress than those on Efavirenz or Nevirapine-based regimens (aPR 0.11, 95% CI 0.08–0.15). All the interviewed healthcare workers lauded IAC for improving ART adherence. However, patient and health care system related factors hindered adherence during IAC. Conclusions The full potential of IAC in achieving viral load suppression in this setting has not been reached due to a combination of the patient and health care system related factors. Provision of adequate IAC necessities and use of patient centered approach should be emphasized to obtain the maximum benefit of the intervention.

Download Full-text

Evaluating the outcomes of enhanced adherence counselling intervention on clients with high viral loads in selected health facilities in Monze.

10.1101/2021.12.18.21267844 ◽

2021 ◽

Author(s):

Martha Kaira ◽

Tresford Sikazwe ◽

John Simwanza ◽

Mowa Zambwe ◽

Peter J. Chipimo

Keyword(s):

Viral Load ◽

High Viral Load ◽

Cross Sectional Study ◽

Health Facilities ◽

Sample Collection ◽

Viral Load Suppression ◽

Cross Sectional ◽

Viral Loads ◽

Adherence Counselling ◽

Counselling Intervention

To investigate the changes in Viral Load(VL) during Enhanced Adherence Counselling (EAC) sessions and its determinants among ART clients with unsuppressed VLs in Monze district. Method: A Cross-sectional study involving 616 HVL ART clients from 15 health facilities in Monze district which was conducted between October 1 2019 and March 30 2021. Results Out of 616 clients analysed, there was an improvement in viral load suppression following completion of EAC with a final outcome of 61% suppression. 28.7% remained unsuppressed. A total of 9.1% had no final viral load results documented and 0.2 % had been transferred out of their respective facilities and were not included in the study. Collection of repeat Viral loads was done on 84% of the clients with high viral load results while 16% had no record of sample collection. A total of 56 results were not received giving a result return of 89% from repeat samples collected. Females had a 40% likelihood of being unsuppressed at 95% CI (41% to 86%) compared to the males. Conclusion EAC improves the outcomes of HVLs and should be encouraged on all high viral clients. Programs should be developed to improve suppression in females on ART

Download Full-text