Factors associated with an unsuppressed viral load among HIV-positive sexually transmitted infected patients attending STI services in South Africa, 2019

Abstract

Background South Africa has a high burden of HIV and sexually transmitted infections (STIs). In the absence of viral suppression, STIs may facilitate the onward transmission of HIV to uninfected partners. We determined factors associated with having an unsuppressed VL among HIV-positive patients attending STI services in South Africa.Methods We conducted a cross-sectional analysis of data on HIV-positive patients attending STI services at STI sentinel sites in Western Cape and Gauteng provinces between January–December 2019 in South Africa. We described the HIV-positive patients attending STI services by demographic and clinical factors. A Poisson regression model was used to identify factors associated with having an unsuppressed VL (> 50 copies/ml), considering a p-value cut-off of 0.25 for inclusion in a multivariable model and 95% CI with P < 0.05 statistically significant.Results Among the 93 HIV-positive patients attending STI services with VL data, the median age was 32 years (IQR 27–37 years). Overall, 32 (34.41%) patients were on ART and 61 (65.59%) were not on ART. The majority of patients (90.63%) on ART were aged ≥ 25 years and 65.20% (61) were male. The median HIV VL was 8011 RNA copies/ml (IQR = 78–99171). More than half of the patients on ART had an unsuppressed VL (56.25%) and 86.89% of those not on ART had an unsuppressed VL. After adjusting for age, gender, STI syndrome and ART use; factors associated with having an unsuppressed VL included age < 25 years (adjusted prevalence rate ratio [aPRR] = 1.25, 95% Confidence Interval [95% CI] = 0.99–1.60) and being female (aPRR = 1.12, 95% CI = 0.64–1.97). ART use was associated with a 33% lower prevalence of having an unsuppressed VL (aPRR = 0.67, 95% CI = 0.49–0.92). In a subgroup of those on ART, after adjusting for sex partner number, patients < 25 years old had a higher likelihood of having an unsuppressed VL (aPRR = 1.94: 95% CI = 1.27–2.97) compared to those aged ≥ 25 years old.Conclusion The proportion of HIV-positive patients attending STI services reporting ART use was low and STI service patients had a high prevalence of having an unsuppressed VL regardless of ART status. These results are below the global target of 95%. Intensified ART support interventions targeted at young HIV-positive, females seeking STI services could improve viral suppression outcomes.