Viral Load Suppression after Enhanced Adherence Counseling and Its Predictors among High Viral Load HIV Seropositive People in North Wollo Zone Public Hospitals, Northeast Ethiopia, 2019: Retrospective Cohort Study

Abstract

Background. The World Health Organization currently encourages enhanced adherence counseling for human immunodeficiency virus (HIV) seropositive people with a high viral load count before a treatment switch to the second-line regimen, yet little is known about viral load suppression after the outcome of enhanced adherence counseling. Therefore, this study aimed to assess viral suppression after enhanced adherence counseling sessions and its predictors among high viral load HIV seropositive people. Methods. Institutional-based retrospective cohort study was conducted among 235 randomly selected HIV seropositive people who were on ART and had a high viral load (>1000 copies/ml) from June 2016 to January 2019. The proportion of viral load suppression after enhanced adherence counseling was determined. Time to completion of counseling sessions and time to second viral load tests were estimated by the Kaplan–Meier curve. Log binomial regression was used to identify predictors of viral re-suppression after enhanced adherence counseling sessions. Result. The overall viral load suppression after enhanced adherence counseling was 66.4% (60.0–72.4). The median time to start adherence counseling session after high viral load detected date was 8 weeks (IQR 4–8 weeks), and the median time to complete the counseling session was 13 weeks (IQR 8–25 weeks). The probability of viral load suppression was higher among females (ARR = 1.2, 95% CI: 1.02–1.19) and higher educational status (ARR = 1.7, 95% CI: 1.25–2.16). The probability of viral load suppression was lower among people who had 36–59 months duration on ART (ARR = 0.35, 95% CI: 0.130–0.9491) and people who had > 10,000 baseline viral load count (ARR = 0.44, 95% CI: 0.28–0.71). Conclusion. This study showed that viral suppression after enhanced adherence counseling was near to the WHO target (70%) but highlights gaps in time to enrolment into counseling session, timely completion of counseling session, and repeat viral load testing after completing the session.

<p>Change in Viral Load Count and Its Predictors Among Unsuppressed Viral Load Patients Receiving an Enhanced Adherence Counseling Intervention at Three Hospitals in Northern Ethiopia: An Exploratory Retrospective Follow-Up Study</p>

“…3,5 This finding is supported by previous studies done in different parts of Africa. [14][15][16] But the finding of the current study is opposing to a finding from a study done inSouth Africa 17 reported EAC has no effect on viral load suppression.…”

“…15 In addition, in Ethiopia, a study was conducted in a similar setting (Hospitals of North Wollo Zone, Ethiopia) among patients with high viral load count, and the study revealed that nearly 66% of patients had viral load suppression after EAC sessions. 16 But, a cluster-randomized study on the effectiveness of EAC in South Africa revealed that enrolling unsuppressed viral load patients in the EAC program for 12 months has no benefit on viral load suppression. 17 In resource-limited settings like Ethiopia, monitoring the change in viral load count among patients who enrolled in the EAC program is useful for clinicians and program designers to examine the effect of EAC on viral load suppression.…”

Long-Term Immunological and Virological Outcomes in Children Receiving Highly Active Antiretroviral Therapy at Hawassa University College of Medicine and Health Sciences, Southern Ethiopia

“…Children being rural residents are statistically significant with immunological and virological failure than urban residents in our study (AOR = 4:912, (1.276-8.815), P = 0:032), which is almost 5 times higher risk to develop immunological 5 Journal of Immunology Research and virological failure. Inconsistency to this finding was reported from Northeast Ethiopia where being an urban resident was significantly associated with virological and immunological failure than a rural resident [30].…”

Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe

“…counseling alone was reported in 30-60% [26,[34][35][36]. These observations provide support for WHO and recent national guidelines which recommend enhanced adherence counseling and a second viral load test>1,000 copies/ml to confirm virologic failure before switching to a protease inhibitor-based or third-line regimen [10].…”