Factors associated with viral load suppression among hiv clients on antiretroviral therapy Inititaed enhanced adherence counselling in Mbeya, Tanzania

Abstract

ABSTRACT Background: HIV clients with viral load above 1000 copies/ml are recommended for enhanced adherence counseling (EAC) to overcome possible barriers to adherence and facilitate viral load suppression (VLS). There is limited information on viral load suppression after EAC and its associated factors in Tanzania. Objective: The aim of this study was to determine the proportion of VLS after EAC among HIV clients on ART for > six months and associated factors. Methods: This was a cross-sectional study design conducted in six health facilities among HIV clients on ART with a viral load above 1000 copies/ml and initiated EAC in Mbeya Region. Data abstraction tool was used to collect information on socio-demographic, clinical, behavioral, and counseling sessions. Data analysis was done using STATA software version 13. Chi-square test was used to compare categorical variables. All predictors with P-value < 0.25 in the bivariate level were entered into multivariate analysis with 95% CI (0.05) to identify independent predictors for VLS while controlling for potential confounders. Results: Of 287 HIV clients enrolled into EAC, the overall VLS was 52.3% (95% CI: 46.6-58.0). Mean time on ART was 5.6 years (SD 2.8). Factors independently associated with VLS on multivariate level were; age above 45 years (aOR=3.6, 95% CI: 1.5-8.6), viral load count below 10000 copies/ml (aOR=5.4, 95% CI: 2.4-12.3), clients at hospital level (aOR=2.7, 95% CI: 1.2-5.7) and > 95% ARV pill count (aOR=3.0, 95% CI: 1.3-6.8). Conclusion: This study reported low proportion of viral load suppression after EAC among HIV clients on antiretroviral therapy. The study shows older age, ARV pill count more than 95%, initial viral load below 10000 copies/ml and clients at hospital level were associated with VLS. These findings confirm the importance of routine viral load testing, EAC and repeat viral load testing before deciding to switch regimen. The study recommends focusing adherence intervention to younger age, mentorship program between health facilities, creating a lasting solution to help quickly identify at the triage clients who have come for EAC and further studies on possible explanation for facility characteristics influencing VLS.