Virological Non-Suppression, Non-Adherence and the Associated Factors Among People Living with HIV on Dolutegravir-Based Regimens: A Retrospective Cohort Study

Abstract

Background HIV is one of the leading causes of morbidity and mortality, with 39.0 million people living with HIV worldwide, 25.6 million of whom reside in the African region. Highly active anti-retroviral therapy (HAART) has improved survival and quality of life, yet some patients develop viral non-suppression. Dolutegravir (DTG) has been recommended since 2018 as a first-line treatment option in low- and middle-income countries owing to its effectiveness, low cost, and tolerability, but some studies have reported virological non-suppression with its use. This study aims to explore the prevalence and factors associated with virological non-suppression in adults taking DTG-based regimens in Mbarara Regional Referral Hospital. Methods A retrospective cohort study was carried out among people living with HIV (PLWHIV) taking DTG-based HAART regimens by way of record review. SPSS was used for analysis, and both binary and multivariate logistic regression analyses were performed to test associated factors. Results Among the 422 participants’ records reviewed, 62.8% were female (median age 40 years, IQR=13). The prevalence of virological non-suppression was 4.2%. Poor adherence to HAART was significantly associated with virological non-suppression, with 100.3 increased adjusted odds (95% CI: 28.90–348.12, p <0.001) compared to those with a record of good adherence. The reasons for poor adherence included alcohol use, stigma, forgetting to take medication, transport problems, and irregular timing of swallowing. Conclusion This study found poor adherence to be associated with a 4.2% prevalence of virological non-suppression among PLWHIV in a large public HIV care clinic. Despite the high suppression rates on DTG-based regimens, adherence counseling and viral load monitoring need to be emphasized at all HIV care centers to mark the trends of virological non-suppression.

Viral load non-suppression status among women exposed to Dolutegravir-based versus Efavirenz-based regimens in Ethiopia: A before-and-after study

“…According to the current study, mothers who poorly adhered to ART were approximately two times at higher risk of developing non-suppressed VL than those with good adherence. This finding is consistent with the studies conducted in Ethiopia, Malawi, Uganda, and sub-Saharan Africa, which found that poor adherence is associated with non-suppressed VL [ 11 , 23 , 24 , 46 , 49 ]. Ensuring good adherence to ART among HIV-positive pregnant and/or breastfeeding women on PMTCT care is essential for improved immunological outcomes [ 12 , 36 ].…”

“…Our study included study participants who were on DTG-based as well as on EFV-based regimens which have better tolerability to enhance ART adherence and subsequent VLS than only the EFV-based regimens. However, the finding is higher than the studies conducted in eastern Ethiopia, South Africa, and Uganda [ 22 , 27 , 28 , 46 ]. The difference might be due to differences in study design, study subject, and operational definition for elevated viral load.…”

Untitled

“…Our study included study participants who were on DTG-based as well as on EFV-based regimens which have better tolerability to enhance ART adherence and subsequent VLS than only the EFV-based regimens. However, the finding is higher than the studies conducted in eastern Ethiopia, South Africa, and Uganda [22,27,28,46]. The difference might be due to differences in study design, study subject, and operational definition for elevated viral load.…”

Untitled

“…Our study included study participants who were on DTG-based as well as on EFV-based regimens which have better tolerability to enhance ART adherence and subsequent VLS than only the EFV-based regimens. However, the finding is higher than the studies conducted in eastern Ethiopia, South Africa, and Uganda [22,27,28,46]. The difference might be due to differences in study design, study subject, and operational definition for elevated viral load.…”