Adherence to viral load testing guidelines, barriers, and associated factors among persons living with HIV on ART in Southwestern Uganda: a mixed-methods study

Abstract

Background Uganda adapted Viral load (VL) testing for monitoring HIV treatment success and virologic failure. However, there is a paucity of data on how the VL testing guidelines are followed in practice in the HIV clinics. This study determined the adherence to national guidelines on VL testing, barriers, and associated factors in persons living with HIV (PLHIV) on ART in southwestern Uganda. Methods We conducted a cross-sectional mixed methods study from April to May 2021 at four HIV clinics in southwestern Uganda. Patient chart review using a checklist that captured age, gender, and level of a healthcare facility, dates of ART initiation, dates VL specimens were drawn, line of ART, patient adherence to ART was done. Continuous data were summarized using mean and median and Chi-square was used for categorical data. We performed regression analysis to determine factors associated with adherence to viral load testing guidelines at a 95% level of significance. Key informant interviews with managers of the health facility, ART clinic and laboratory were carried out, and thematic analysis was conducted to explore barriers to adherence to VL testing guidelines. Results The participants’ mean (SD) age was 39.9(± 13.1) years, 39.5% were male, 45.8% received care at a general hospital and median duration on ART was 5 years (IQR;3–7). Of the 395 patient charts reviewed, 317 had their VL testing (80.3%) per the guidelines (defined as up to one month post due date). Receiving care at a hospital (aOR = 2.20; 95%CI 1.30–3.70; p = 0.002) and increasing patient age (aOR = 1.02; 95%CI 1.02–1.06; p = 0.020) were the factors associated with adhering to VL testing guidelines. Long turnaround time of VL results and insufficient VL testing kits were cites by providers as barriers. Conclusion We found suboptimal adherence to VL testing guidelines in PLHIV on ART in southwestern Uganda. Increasing patient age and getting care at a higher-level health facility were associated with guideline-based viral VL testing. Long turnaround time of VL test results and inadequate test kits hindered compliance to VL monitoring guidelines. Strategies that target young PLHIV and lower-level health facilities, increase the stock of consumables and shorten VL results turnaround time are needed to improve adherence to VL testing guidelines.

Compliance to Viral Load Monitoring Schedules Among Women Attending Prevention of Vertical HIV Transmission Services Before and During the COVID-19 Pandemic in Ehlanzeni District, Mpumalanga, South Africa

“…Although the message of delayed implementation of guidelines is undeniable, the observed levels of compliance to VL testing are best interpreted as an over-estimation. This study had a higher (~ 82%) compliance to repeat VL testing among PVT clients during pre-COVID-19 compared to what was reported for the general population during 2016 in South Africa (47.7–56.4%) [ 35 ], and what was seen among PVT clients in Kenya (only 6% of repeat VL testing within recommended schedule) [ 25 ] and Republic of Moldova during the COVID-19 pandemic among PWHIV (28.6%) [ 28 ], but comparable to observations of a similarly small PWHIV sub-population in southwestern Uganda (80.3%) [ 55 ]. A high proportion of women were excluded because of only one VL test observed (102/667) in the NHLS-DW, despite searching nation-wide routine data to account for women’s mobility.…”

“…The insignificance of age in the COVID-19 period sub-analyses, regardless of PVT-guidelines used, could be due to the universally enforced COVID-19 movement restrictions. Other participant sociodemographic factors such as education and income were not risk factors unlike in other related PVT indicators [ 50 , 51 , 54 , 55 ].…”

Safeguarding strategies and current HIV treatment in the UK

“…Apart from instigating severe infections through immune suppression, HIV is implicated in cardiovascular and bone diseases, as well as liver and kidney dysfunction [1]. Despite reported success in HIV-related interventions diminishing disease-related morbidity and mortality [2], the UK Health Security Agency's report underscores AIDS as an enduring public health concern [3]. Due to the delayed manifestation of symptoms, addressing the complexity of the disease becomes challenging.…”

Point-of-Care Viral Load Testing to Manage HIV Viremia During the Rollout of Dolutegravir-Based ART in South Africa: A Randomized Feasibility Study (POwER)

“…Although the importance of achieving rapid viral resuppression is clear, several studies in low-and middleincome countries (LMICs) have documented long periods of sustained viremia because of poor clinical management, with associated increased morbidity and mortality. [2][3][4][5][6][7][8][9] In these settings, HIV services are predominantly provided in primary care, where delays in receiving VL results from centralized laboratories 10 can further impede management of viremia. New diagnostic strategies to improve the detection of viremia and achieve rapid viral resuppression are needed.…”

“…In these settings, HIV services are predominantly provided in primary care, where delays in receiving VL results from centralized laboratories 10 can further impede management of viremia. New diagnostic strategies to improve the detection of viremia and achieve rapid viral resuppression are needed.…”