Prevalence and factors associated with viral load suppression among people living with hi in Mwanza, Tanzania

Abstract

Background: Viral load is the quantification of Human Immunodeficiency Virus (HIV) in blood of an infected person. Viral load testing helps in assessing the effectiveness of treatment in People Living with HIV (PLHIV) to prevent them from developing AIDS. Clients with viral load of <1000copies/ml are considered suppressed. According to the Tanzania HIV Impact Survey (THIS) report, only 9% of clients eligible for HVL were tested for viral load in year 2016 and among those tested the overall viral suppression was 51.9%, and the suppression rate for Mwanza was 49.6%.There have been efforts done by the Government and different stakeholders to ensure that VL suppression of 95% and above is achieved country wide. The current prevalence of VL suppression is unknown, and factors associated with suppression have not been established for Mwanza, Tanzania.

Objective: The objective of the study was to determine the current prevalence of viral load suppression and the factors associated with viral suppression in Mwanza region, North West Tanzania.

Materials and Methods: This was an epidemiological study, with secondary data analysis and quantitative cross sectional study. The study population was generated from a large national routine care and treatment clinic (CTC) database at Ukerewe DC and Mwanza CC. Study participants were recruited using systematic random sampling. Information on viral load testing and test results were obtained from the CTC database, while factors associated with viral load suppression were obtained through individual interviews with clients. Data was analyzed using STATA version 14 program. Frequencies and percentages for testing and suppression rates were determined and logistic regression models were used to determine the strength and direction ofassociation between independent variables and viral load suppression.

Results: A total of 6206 eligible clients were extracted from selected facilities CTC2 data base from January 2016 to December 2018. 415 clients were interviewed from the eligible clients. The overall viral load testing rate was 67%. Database analysis showed that as years progressed the percentage of HVL eligible clients who were tested increased from 18% in 2016 to 86% in 2018. However, the testing frequency is still low, with the majority of clients (80.2%) having been tested only once, and only 2.3% of clients tested more than 2 times. In the cross sectional study, 88% of clients were tested for HVL, and among them, 94% had viral suppression. In multivariate analysis, only four factors: treatment regimen used, adherence level reported, pills burden and active TB infection/other infection were found to be significant predictors of viral load suppression.

Conclusions: Test coverage has increased significantly from the national coverage of 7.3% reported in 2016 to 88%. The observed viral suppression of 94% is closing the gap to reach 95%, the third UNAIDS 2030 goal. Non-adherence to medication contributes to clients not attaining viral suppression. Clients with TB/other infections have a challenge of attaining suppression, as are clients on the second line regimens and clients using two or more pills a day.