Factors Leading To Elevated Viral Load among HIV Infected Individuals Receiving Antiretroviral Therapy in Pwani Region, Tanzania

Abstract

Background: Antiretroviral therapy (ART) has dramatically reduced HIV-associated morbidity and mortality and has transformed HIV disease into a chronic, manageable condition. The quantification of viral load in plasma is a determinant of the progression of the disease and, along with CD4 lymphocyte counts, has been used to monitor therapeutic responses in HIV patients on ART. Objective: To determine the factors leading to elevated viral load among HIV infected individuals receiving ART in Pwani region Tanzania. Methodology: This study was analytical cross sectional facility based among a cohort of Patient attending three hospitals in Pwani Region. The study was conducted for a period of 12 months using viral load data collected at care and treatment clinic (CTC) in Pwani region from June 2016 to May 2017. A total of 482 HIV infected individuals enrolled on ART in Pwani region were included in this study. Plasma viral load results were obtained from patient’s medical record files. Structured questionnaires were administered to participants to gather information on factors associated with elevation of viral load. Viral load was also tested after 12 months or more of using ART i.e. six months from the initial viral load test. Data analysis was done using Epi info version 3.5.1. Chi squared-Mantel-Hansel test was used to for comparison of proportions. Logistic regression and multivariate analysis were used to analyze factors associated with elevated viral load. Results: A total of 482 HIV infected individuals were recruited in the study. The proportion of participants with elevated viral load (>1000 copies/mL) was 188 (39%). The median viral load results obtained in patients’ medical records after period of six months or more of using ART was 12368 copies/mL (IQR=3999-47236) which decreased significantly to 437 copies/mL (IQR=20-9303) after being on enhanced adherence counseling and close follow up by health worker. In this study, we found the following factors were significantly associated with elevated viral load; HIV infected individuals who had not disclosed their HIV status were four times more likely to have elevated viral load compared to those who disclosed their HIV status (OR=3.78 95% CI (1.78-7.88). HIV infected individuals who did not attend enhanced adherence counseling were three times more likely to have elevated viral load compared to those who attended (OR= 3.08 95% CI (1.74- 5.46). Those who reported to be taking alcohol were three times more likely to have elevated viral load compared to those who reported not to be taking alcohol (OR=3.49 95% CI (2.09 – 5.82). Moreover, individuals who were not members of psychosocial groups were three times more likely to have elevated viral load compared to those who were members of psychosocial groups (OR=2.64 95% CI (1.28-5.44). Participants who reported to take two meals or less per day were two times likely to have elevated viral load compared to those who reported to take more than two meals per day (OR= 1.64 95% CI (1.13-2.38). HIV infected individuals who could not take medication on an empty stomach were four times more likely to have elevated viral load compared to those who were able to take medication even on empty stomach (OR= 4.03 95% CI (2.47- 5.98), Conclusion: While ART has made it possible to significantly decrease of HIV related morbidity and mortality, this study found a high proportion (39.%) of individual had elevated viral load despite being on ART for 12 months or more. The factors which influence the elevation of viral load in patients using ART in Pwani region, included taking alcohol, taking few meals per day, not attending EAC session, failing to take medication in empty stomach, consuming few number of meals per day, not being member of psychosocial group and failing to disclose their HIV status. This study also found that being depressed or having illness, forgetting or being busy, unavailability of ART at the clinic, change of daily routine were among the reasons for non-adherence to ART. Recommendation: Emphasis should be made by health-care providers to enhance adherence and counseling to all HIV infected patients at the time of ART initiation. Patients should also be encouraged by health care providers to join a psychosocial group where they will receive psychosocial support to help them to cope with fear of disclosing their HIV status as well as stigma. We also recommend for another study to assess the role of antiretroviral drug resistance on persistence of high level HIV viral load, particularly for patients with elevated viral load after 12 months of ART despite being on enhanced adherence and counseling groups.