Factors associated with adherence and viral suppression among patients on second-line antiretroviral therapy in an urban HIV program in Kenya

Abstract

Objective: The aim of this study is to estimate the proportion of virologically suppressed People living with HIV on second-line ART and to identify factors associated with virologic suppression. With an increasing population of patients on complex second-line anti retroviral therapy (ART), understanding the factors associated with viral suppression and adherence is critical for ensured longevity of ART. Methods: A retrospective study was conducted of patients on second-line ART in 17 facilities supported by University of Maryland, Baltimore, in Nairobi, Kenya, covering the period beginning October 2016 up to August 2019. Viral suppression was defined as viral load <1000 copies/mL in a test conducted in the last 12 months. Adherence was assessed through self-reports and classified as optimal (good) or suboptimal (inadequate/poor). Associations were presented as adjusted risk ratios with 95% confidence intervals. Statistical significance was considered when p value ⩽0.05. Results: Of 1100 study participants with viral load data, 974 (88.5%) reported optimal adherence while on first-line ART and 1029 (93.5%) reported optimal adherence to second-line ART. Overall, viral load suppression on second-line ART was 90%. Optimal adherence ((adjusted risk ratio) 1.26; 95% confidence interval 1.09–1.46)) and age 35–44 versus 15–24 years ((adjusted risk ratio) 1.06; 95% confidence interval 1.01–1.13)) were associated with viral suppression . Adherence to first-line ART ((adjusted risk ratio) 1.19; 95% confidence interval 1.02–1.40)) was associated with adherence to second-line ART. Conclusion: Viral suppression remains high and adherence was strongly associated with viral suppression, underscoring the need to adequately address the barriers to adherence before switching regimens.

Age and gender profiles of HIV infection burden and viraemia: novel metrics for HIV epidemic control in African populations with high antiretroviral therapy coverage

“…Second, our study only considered data from Uganda, and our results may not directly generalize to other settings. However epidemiological patterns reported here are typical of ESA, such as: expansive population pyramids [27], patterns in HIV prevalence by age and gender [44], and gender gaps in suppression levels [12,[33][34][35][36][37][38][39][40]. These observations suggests that the major contributions of individuals aged 25-34 to the burden of viraemia may generalize across the subcontinent.…”

“…For example, in inland communities, we found that young individuals aged 15-24 constituted approximately two fifths of the census-eligible population, but only one fifth of the population exhibiting viremia. In fact, the lower suppression levels commonly reported among young PLHIV [12,[33][34][35][36][37][38][39][40] are counterbalanced by the small absolute number of young PLHIV. This observation is typically missing from studies supporting prioritization of younger age-groups in ESA based on the UNAIDS targets 45 .…”

Viral Load Suppression and Associated Factors Among Hiv-Infected Patients on Second-Line Antiretroviral Therapy at Public Health Facilities of West Guji, Guji and Borena Zones, Southern Ethiopia: Facility Based Cross-Sectional Study

“…Study findings of cohort study in Africa showed that among PLWHA with ART experience and viral suppression, those who moved to tenofovir/lamivudine/dolutegravir (TLD) maintained viral suppression better than those who persisted on other regimens (8). The HIV program in Kenya reported that second-line ART users had a viral load suppression rate of 90% (9). Findings revealed that among 46.8% of HIV patients on second-line ART, 88.2% achieved viral load suppression (4).…”