Incidence and Predictors of Viral Load Suppression After Enhanced Adherence Counseling Among HIV-Positive Adults in West Gojjam Zone, Amhara Region, Ethiopia

Abstract

Background Viral load suppression among people living with HIV is the main goal of antiretroviral therapy (ART). The most cause for high viral load is poor adherence to ART. World Health Organization (WHO) recommends intensive enhanced adherence counseling for people with a high viral load, which is greater or equal to 1000 RNA copies per mL and at least on treatment for six months. However, little is known about the outcome of enhanced adherence counseling. The study aimed to assess the incidence of viral load suppression after enhanced adherence counseling and its predictors among HIV-positive adults in high caseload health facilities in the Amhara region, Ethiopia. Methods An institution-based retrospective follow-up study was employed among 346 HIV-positive adults enrolled in enhanced adherence counseling in a high caseload health facility in the West Gojjam zone from June 2016 to June 2020. The data on relevant variables were collected from the patient’s medical cards by trained data collectors. The collected data were entered into EpiData version 3.1 and then exported to Stata version 14 for analysis. Descriptive analysis was performed to describe the variables. Cox proportional regression model was used to identify independent predictors of viral load suppression after enhanced adherence counseling. Results Overall, 51.73% of the study participants achieved viral load suppression after enhanced adherence counseling. The incidence of viral load suppression rate was 11.17 per 100-person month. During the multivariate analysis, it was observed that being female (AHR = 1.50, 95% CI: 1.05–2.15), CD4 count of greater than or equal to 350 cells/mm 3 (AHR = 1.98, 95% CI: 1.12–3.51) and no recurrent OI (AHR = 1.85, 95% CI: 1.06–3.24) were an independent predictor of viral load suppression after enhanced adherence counseling. Conclusion Incidence of viral load suppression rate was still far from the WHO target (70%). Therefore, higher priority should be given to patients with low CD4 counts with improved enhanced management of opportunistic infections.

Time to Viral Load Suppression and Its Predictors Among Adult Patients on Antiretro Viral Therapy in Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Southern Ethiopia

“…The overall incidence rate of viral load suppression was 9.68 per 100 person months (95% CI = 8.56, 10.94). This finding is lower than the incidence rate found in the study conducted in the study done in West Gojjam zone, Amhara region (11.17 per 100 person-months), 24 but higher than the study conducted in Kenya (3.9 per 100 person month). 11 The differences in socioeconomic status, quality of care provided, type of ART treatment regimen, ART treatment adherence level, and some co-morbidity might explain the variation in incidence rate among studies.…”

“…The median time to viral load suppression was 9 months (95% CI: 8.22, 9.78). This was longer than studies conducted in Arbaminch hospital, Southern Ethiopia (3 months); 20 Oromia, Ethiopia (181 days); 21 west Gojjam zone, Amhara region (5 months) 24 and New York (50 days). 7 This difference in might be due to the difference in the quality of care, the patients’ behavior like adherence, and clinical characteristics of the patient.…”

Virological suppression rate and its predictors among HIV/AIDS patients on antiretroviral therapy before and during the COVID-19 pandemic in Ethiopia: Systematic review and meta-analysis

“…Patients with a normal BMI (18.5-24.9kg/m 2 ), according to the WHO classi cation, were more likely to achieve viral load suppression, which is in line with the ndings of primary studies (18), this is because BMI has a predictive impact on immune recovery, which is crucial for controlling viral replication. Additionally, the baseline CD4 count of patients was found to determine virological suppression, which is consistent with previous studies (19,20). CD4 count plays a vital role in immune function, protecting the body against opportunistic infections and the multiplication of the virus.…”

“…The study found through database searching was performed between 2011 and 2022. Regarding the study area/region, seven studies were conducted in the Amhara region (19,24,25,26,27,28,29), six studies in the Oromia region (20,30,31,32,33,34), ve studies in the South Nation and Nationalities and Peoples of Ethiopia (SNNPE) region (18,35,36,37,38), one study in the Tigray region (39) and two studies in the Addis Abeba city administration (40,41).…”

“…By study design, ten studies were conducted using a cross-sectional study design (18,24,27,31,32,33,34,36,38,39), two studies were conducted using a case control study design (30,40), eight studies were conducted using a retrospective cohort stud (19,20,25,26,28,29,35,41) and one study was conducted using a prospective cohort study (37). Nine studies were conducted on rst-line ART patients (20,25,30,32,33,35,36,37,41), nine studies were conducted on both rst-and second-line ART patients (18, 19,24,27,28,31,34,38,39,40), and two were conducted on second-line ART patients (26, 29). The minimum sample size was 152 taken in the study in Arba Minch (37), and the maximum sample size was 19,525 used in the study in the Tigray region (39) for detail (Table 1).…”