Patient related predictors of virological non- suppression among HIV infected individuals on antiretroviral therapy :

Abstract

Background: In Uganda, recent data about viral load non-suppression among HIV infected individuals on antiretroviral treatment is relatively scarce and this complicates the design of effective HIV/AIDS mitigation strategies. The purpose of this study was to determine the proportion and predictors of viral load non-suppression among HIV patients on ART in Alebtong district, Northern Uganda. Methods: A retrospective cohort analysis of 323 HIV positive patient records from July 2016 to June 2017 was conducted at Alebtong Health Center IV. Data was collected using a data abstraction tool and was summarized using descriptive statistics. A chi square test was done to assess the association between viral load suppression status and other covariates. Multivariable logistic regression was used to determine the predictors of virological non-suppression. The data were analyzed using STATA version 14 software. Results: Of the 323 patient records reviewed,159(49.2%) were males and 164 (50.8%) females.250 (77.7%) were between 13 to 49 years, 42 (13.2%) were 13 years and below, 30(9.3%) were 50 years and above. About 53% (n=170) had non-suppressed viral load, 66% (n=213) had >95% adherence to ART. Late initiation (>3months) on ART increased the odds of poor viral load suppression (AOR 57.0, 95% CI 12.27-264.97). Poor adherence (=95%) to ART was a strong predictor of viral load nonsuppression (AOR 37.4, 95% CI 10.1-137.9). Weight above 20kg was significantly protective against viral load non-suppression (AOR 0.008, 95% CI 0.001-0.068). Conclusion: Only 47.4% of patients receiving ART at Alebtong HC IV achieved viral load suppression in the period July 2016 to June 2017. This is about half way the 90-90-90 global HIV treatment target of 2020. Late initiation on ART and poor adherence to ART are predictors of viral load non-suppression. Recommendations: HIV patients in Alebtong should be initiated onto ART at the earliest possible time regardless of WHO clinical staging or CD4 count up on confirmation and should be supported to maintain good adherence to minimize viral load non-suppression in this population.