HIV Viral Load Monitoring Among Patients Receiving Antiretroviral Therapy — Eight Sub-Saharan Africa Countries, 2013–2018

Lecher, Shirley Lee; Fonjungo, Peter N.; Ellenberger, Dennis; Toure, Christiane Adje; Alemnji, George; Bowen, Nancy; Basiye, Frank; Beukes, Anita; Carmona, Sergio; Klerk, Michael de; Diallo, Karidia; Dziuban, Eric J.; Kiyaga, Charles; Mbah, Henry A.; Mengistu, Johannes; Mots'oane, Tsietso; Mwangi, Christina; Mwangi, Jane; Mwasekaga, Michael; N’tale, Jonathan; Naluguza, Mary; Ssewanyana, Isaac; Stevens, Wendy; Zungu, Innocent; Bhairavabhotla, Ravikiran; Chun, Helen M.; Gaffga, Nicholas; Jadczak, Stephen; Lloyd, Spencer; Nguyen, Shon; Pati, Ritu; Sleeman, Katrina; Zeh, Clement; Zhang, Guoqing; Alexander, Heather

doi:10.15585/mmwr.mm7021a2

Cited by 39 publications

(42 citation statements)

References 6 publications

(8 reference statements)

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“…All HIV VL data collected between 1 January 2021 and 31 December 2021 were included in this study. The response variable was suppressed VL (defined as having a VL below 1000 copies [13, 14]. The independent variables were: age at sample collection, sex, facility location (rural/urban), reason for VL testing (routine/targeted), current first‐line ART regimen, sample type (plasma/dried blood spot [DBS]) and region (north/central/south).…”

Section: Methodscontrasting

confidence: 77%

Factors associated with HIV viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System

Ng’ambi

Estill

Jahn

et al. 2022

Tropical Med Int Health

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To describe the prevalence of HIV viral suppression and assess the factors associated with HIV viral suppression among persons receiving antiretroviral therapy (ART) in Malawi in 2021. Methods: Implementation study using routinely collected patient-level HIV RNA-PCR test result data extracted from the national Laboratory Management Information System (LIMS) database managed by the Department of HIV/AIDS in 2021. We calculated frequencies, proportions and odds ratios (OR) of HIV viral suppression with their associated 95% confidence intervals (95%CIs). We performed a random-effects logistic regression to determine the risk factors associated with HIV viral suppression among ART patients, controlling for the spatial autocorrelation between districts and adjusting for other variables. Results: We evaluated 515,797 adults and children receiving ART and having a viral load test in 2021. Of these, 92.8% had HIV viral suppression. ART patients living in urban areas had lower likelihood of HIV viral suppression than those living in rural areas (adjusted OR [aOR] = 0.95, 95%CI: 0.92-0.99, p = 0.01). There was an increasing trend in HIV viral suppression with increasing ART duration. Routine VL monitoring samples were 39% more likely to have suppressed VL values than confirmatory HIV VL monitoring samples (aOR = 1.39; 95%CI: 1.34-1.43, p < 0.001). Conclusion: This is the first national analysis of Malawi HIV VL data from LIMS. Our findings show the need to particularly consider the urban residents, those below 20 years, males, those on ART for less than a year as well as those on specific ARV regimens in order to persistently suppress HIV VL and consequently achieve the goal of achieving HIV VL suppression by 2030.

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Section: Methodscontrasting

confidence: 77%

Factors associated with HIV viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System

Ng’ambi

Estill

Jahn

et al. 2022

Tropical Med Int Health

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“…However, difficulty accessing affordable viral load testing materials and technology remains a significant issue in some settings. 22 Despite adult and pediatric sites having an overall decrease in the proportion of ART failure detected as immune failure and an increase in the proportion of ART failure detected as viral failure, both mainly attributable to changes in lower middle-income countries, the overall proportion of ART failure detected as clinical failure remained relatively stable. Further investigation of this finding may be warranted to ensure that HIV treatment centers in the region are not oversimplifying ART laboratory monitoring in response to recent guideline changes encouraging greater efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…However, difficulty accessing affordable viral load testing materials and technology remains a significant issue in some settings. 22…”

Section: Discussionmentioning

confidence: 99%

Recent Trends in Adult and Pediatric Antiretroviral Therapy Monitoring and Failure

Boettiger

Kumarasamy

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…However, based on other published reports, delays are likely related to individual and systemic issues, with individual reasons including lack of treatment literacy leading to poor adherence to visit schedule, long distance to medical facility, lack of time off from work, and limited financial resources [ 16 – 18 ]. Systemic issues like prolonged waiting times at treatment centers, delayed turnaround times due to equipment breakdowns and difficulty in specimen transport have also been cited [ 18 , 19 ]. Different evidence-based mitigation measures to reduce these delays include community testing models where samples are collected at community level during peer support groups and transported to the facility for testing rather than waiting for the patients to come to the facility for testing [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

An empiric tool to identify Kenyans living with HIV who will have unsuppressed viremia 18 months following treatment initiation to guide differentiated care models

et al. 2022

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Background With the global push towards universal access to Antiretroviral Treatment (ART), patient numbers are increasing, further straining already under-resourced healthcare systems in sub-Saharan Africa. A simple scoring tool could be useful in optimizing differentiated service delivery by identifying individuals likely to have unsuppressed viral load. Methods Using existing data of patients accessing ART at public health facilities that were extracted from the Kenya Electronic Medical Record (KenyaEMR) and standard methods of developing a clinical prediction tool; we created and validated a risk scoring tool to identify persons likely to be virally unsuppressed at 18 months post-ART initiation. Data from the KenyaEMR were cleaned, merged and reviewed for completeness. We utilized multivariate modelling to determine key predictors of viral load suppression that could be measured in clinical settings. Results We assessed clinical reports of 3,968 patients on ART who had been on ART for at least 18 months and had at least one viral load result and were ≥ 18 years old. Of these, the majority (81%) were virally suppressed 18 months post-ART initiation. The final risk score included age, sex, body mass index at HIV diagnosis, number of years of formal education, disclosure status, and duration of time between HIV diagnosis and initiating ART. The maximum risk score was 78; a risk score of ≥22 was associated with unsuppressed viral load (>1000copies/mL). The area under the curve (AUC) for the probability of the risk score to correctly predict unsuppressed viral load was 0.55 (95% CI: 0.52 to 0.56). Internal and external validation showed similar predictive ability. Conclusions Routinely collected variables in a public HIV clinic medical record predicts, with modest accuracy, individuals likely to have unsuppressed HIV viremia 18 months after they initiate ART. The use and application of this tool could improve and complement efficiency in differentiated care models for patients on ART.

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HIV Viral Load Monitoring Among Patients Receiving Antiretroviral Therapy — Eight Sub-Saharan Africa Countries, 2013–2018

Cited by 39 publications

References 6 publications

Factors associated with HIV viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System

Factors associated with HIV viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System

Recent Trends in Adult and Pediatric Antiretroviral Therapy Monitoring and Failure

An empiric tool to identify Kenyans living with HIV who will have unsuppressed viremia 18 months following treatment initiation to guide differentiated care models

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