Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

Abstract

IntroductionThis study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland.MethodsThis descriptive study used laboratory data from 7/5/2012 to 30/9/2013, which were linked with the national ART database to provide information on time on ART and CD4 count; information on enhanced adherence counselling was obtained from file review in health facilities. Multivariable logistic regression was used to explore the relationship between viral load, gender, age, time on ART, CD4 count and receiving (or not receiving) enhanced adherence counselling.ResultsFrom 12,063 patients undergoing routine viral load monitoring, 1941 (16%) had detectable viral loads. Children were more likely to have detectable viral loads (AOR 2.6, 95%CI 1.5–4.5), as were adolescents (AOR 3.2, 95%CI 2.2–4.8), patients with last CD4<350 cells/µl (AOR 2.2, 95%CI 1.7–2.9) or WHO Stage 3/4 disease (AOR 1.3, 95%CI 1.1–1.6), and patients on ART for longer (AOR 1.1, 95%CI 1.1–1.2). At retesting, 450 (54% of those tested) showed viral re-suppression. Children were less likely to re-suppress (AOR 0.2, 95%CI 0.1–0.7), as were adolescents (AOR 0.3, 95%CI 0.2–0.8), those with initial viral load> 1000 copies/ml (AOR 0.3, 95%CI 0.1–0.7), and those with last CD4<350 cells/µl (AOR 0.4, 95%CI 0.2–0.7). Receiving (or not receiving) enhanced adherence counselling was not associated with likelihood of re-suppression.ConclusionsChildren, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.

Antiretroviral Treatment and Resistance Patterns in HIV-Infected Children

“…Extra efforts should be taken to address adherence issues, develop routine adherence monitoring and take into account the children's age and disease status in order to avoid making unsuitable switch to second-line therapy especially when interpreting VL. In settings where feasible, consistent VL measurements and resistance genotyping are advised when dealing with suspected DR cases [38,42]. Newly developed diagnostic methods are platforms for improved quality of detections especially for minor variant DRMs [46].…”

“…At retesting, about half of the study population who were children and adolescents were less likely to achieve viral re-suppression. These findings suggested that those who did not re-suppressed are more likely to have resistance mutations [38][39][40]. A research carried out on children living with HIV in Rhodes Island, USA, reported high HIV-1 diversity with widespread drug resistance among ART-experienced participants [41].…”

“…Jobanputra et al [38] explored factors associated with virological detectability, subsequent virologic failure and also established whether receiving enhanced adherence counselling is associated with likelihood of viral re-suppression in children, adolescents and adults with initial detectable viral load in Swaziland. Children, adolescents, patients with advanced disease and those on ART for longer duration were found to be more likely to have detectable VLs.…”

Does research through Structured Operational Research and Training (SORT IT) courses impact policy and practice?

“…This is one of the limitations of self-reported data. A participant from Swaziland mentioned that the decision on policy would have been made based on analysis of routine data, irrespective of its publication in a journal, although publication increased the credibility of the findings: 31 This is a really an issue of how literally you expect respondents to take the question. If I answer the question as it was phrased, then the answer is no-it was not the study per se that led to policy change, but rather the use of routine data to feed the advocacy efforts of MSF and Clinton Health Access Initiative (Kigali, Rwanda)-this would have happened regardless of the study.…”

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

“…Its continued positive clinical impact depends on taking more than 95% of prescribed doses (Jobanputra et al, 2015;WHO, 2013;Zoufaly et al, 2013;Bhattacharya & Dubey, 2011;MOH, 2007). Several factors affect the rate of treatment adherence among children including drug regimen, caregivers, and society and culture related factors (Castro, Gonzalez, & Perez, 2015;Haberer & Mellins, 2009) (Hagstromer, Lundstedt, Balcha, & Bjorkman, 2013;Muller et al, 2011), (Reda & Biadgilign, 2012).…”