Process evaluation of the implementation of enhanced adherence counselling among HIV patient with unsuppressed viral load in Dar es salaam, Tanzania

Abstract

ABSTRACT Background: Despite advancements in antiretroviral therapy, HIV remains a significant global health challenge, particularly in Tanzania, which has a 4.65% prevalence rate. Enhanced Adherence Counselling (EAC), introduced by the World Health Organization in 2016, aims to improve adherence among patients with unsuppressed viral loads (VL). However, many patients in Tanzania still struggle to achieve VL suppression post-EAC. Objective: This study evaluates the implementation of EAC among HIV patients with unsuppressed VL in Ilala Municipality, Dar es Salaam. Methods: A cross-sectional descriptive study was conducted, combining quantitative and qualitative methods. Multistage sampling was employed to select eight care and Treatment Clinics (CTCs) in Ilala, categorized by client load, with a random sampling approach applied to ensure representation. Quantitative data were collected from existing patient records using a pretested data extraction form on Open Data Kit (ODK). While qualitative data collected using Key informant interview using interview guide. Quantitative data was analyzed using STATA SE 14 (64-bit) software while thematic analysis using NVivo software was used to analyses qualitative data. Descriptive and ordered logistic regression analysis were performed at p < 0.05. Multivariable logistic regression analysis was conducted to assess the independent association between various factors and viral load suppression. Results: Out of 361 patients, 86.2% were enrolled in EAC, with age significantly associated with enrollment. Among the 256 who completed EAC, 68.4% achieved VL suppression. Factors such as initial VL levels and age significantly correlated with suppression rates. Qualitative findings revealed that while counsellors understood EAC protocols, they faced challenges including outdated training and resource limitations. The median time to initiate EAC after high VL detection was 27 days, and most clients completed EAC within three months. Conclusion: The study demonstrates a high enrolment rate of 86% among patients with unsuppressed viral loads (VL) in the Enhanced Adherence Counseling (EAC) program, vi leading to a suppression rate of 64.4%, which approaches the WHO target of 70%. Initial viral load levels were found to be predictive of treatment success. However, barriers such as resource shortages and logistical delays hinder the program from reaching its full potential. Addressing these challenges is crucial to improving ART adherence and viral load outcomes. Future research should focus on interventions to optimize EAC implementation and explore patient perspectives to inform best practices.