Viral Suppression and Its Associated Factors in HIV Patients on Highly Active Antiretroviral Therapy (HAART): A Retrospective Study in the Ho Municipality, Ghana

Abstract

Background. The WHO targets to end HIV/AIDS as a public health problem by 2030. The introduction of the ambitious “90-90-90” strategy to attain this target is expected to be achieved by the year 2020. However, there is lack of regional data, especially on the third “90.” This study sought to assess the rate and associated factors of viral suppression among people living with HIV (PLWH) on highly active antiretroviral therapy (HAART) at the Antiretroviral Therapy (ART) Clinic in a Ghanaian health facility. Method. The study design was a retrospective analysis of secondary data of 284 HIV registrants on HAART for at least 6 months at the ART Clinic from July 2016 to April 2019. Data on sociodemography including age, gender, marital status, education, and occupation as well as pharmacological (type of medication and duration on medication) and laboratory variable (current viral load results) were extracted from patients’ folders. Viral suppression and failure were determined using the WHO definitions (viral suppression as viral load <1000 copies/ml and virologic failure ≥1000 copies/ml). Regular clinic attendance (used as a proxy measure for medication adherence) was defined as consistent monthly clinic attendance for HAART medication and other clinical management within the past 12 months. Results. Out of the 284 HIV patients, 195 (69%) achieved viral suppression. Of the 195 who were virally suppressed, 77 (39.5%) had undetectable levels, with a similar proportion (39.5%) achieving viral load results ranging from 20 to 200 copies/ml. Moreover, 27 (13.8%) patients had viral load ranging from 201 to 500 copies/ml while 14 (7.2%) recorded viral load from 501 to 1000 copies/ml. No clear pattern in the viral suppression rate was associated with the age groups (p=0.1152). However, regular clinic attendance (used as proxy for medication adherence) (p<0.0001) and being on HAART for more than three (3) years (p=0.03) were associated with viral suppression. Conclusion. The rate of viral suppression among PLWH on HAART in the Ho municipality fell short of the WHO target. However, the study identified regular ART clinic attendance and treatment >3 years as factors associated with viral suppression.

Viral suppression and predictors among adolescents receiving care for HIV/AIDS in a tertiary health centre in Uyo, South-South, Nigeria

“…The small sample size might have affected this finding. This also contrasts with the findings of Lokpo et al (2020) where regular clinic attendance was significantly associated with viral suppression (p=0.0001). This could be due to the practice of giving a week's medication in excess of appointment which makes clients miss appointment dates when they have medications at home.…”

Low level of tuberculosis preventive therapy incompletion among people living with Human Immunodeficiency Virus in eastern Uganda: A retrospective data review

“…Furthermore, adherence to clinic visits is closely linked to good adherence to medications [31] . A recent study reports a high proportion of unsuppressed viral load among participants non-adherent to HIV clinic visits and a high proportion of suppressed viral load among those adherent to the visits [25] . Missed clinic appointments have been linked to unsuppressed viral load and delayed immune recovery [32] , [33] .…”

“…Our data show that non-adherence to ART clinic visits on one hand, and patient representation, on the other hand, are associated with an increased likelihood of TPT incompletion. Adherence to clinic visits is an important proxy measure for adherence to ART [25] , [26] . ART clinic attendance is an important component of comprehensive HIV care as it enables service providers to track patient clinical progress and offers a valuable opportunity to receive health information.…”

Determinants of viral load non-suppression among people living with HIV on antiretroviral therapy in Kumasi, Ghana

“…89 non-suppression out of 284 HIV-positive patients). 11 What this implies is that there might be variations in the proportion of HIV-infected people achieving viral load suppression in different parts of the country.…”

“…The authors found regular ART clinic attendance and treatment >3 years as factors associated with viral suppression. 11 The present study builds on the above studies by determining the rate and factors associated with viral load non-suppression among adults living with HIV/AIDS on active ART at Kumasi in the Ashanti Region of Ghana. Findings could inform policy decisions and strategies in improving care and attaining the 90-90-90 and the 95-95-95 targets.…”