Factors associated with viral load non-suppression in people living with HIV on ART in Nigeria: cross-sectional analysis from 2017 to 2021

Abstract

ObjectivesIdentify factors (demographic and clinical) associated with a non-suppressed viral load (VL) of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria.DesignCross-sectional study.SettingSixteen US Agency for International Development supported states in Nigeria.Participants585 632 PLHIV on ART.Primary outcome measuresVL non-suppression (defined as having a VL of at least 1000 HIV RNA copies per mL of plasma). χ2testing and multivariable modified Poisson regression with robust variance estimates were conducted on routinely collected ART programme data.ResultsSixty-six per cent of the study population were females. The largest age groups were 25–34 and 35–44, accounting for 32.1% and 31.1%, respectively. Males had a 9% greater likelihood (adjusted prevalence ratio, APR=1.09) of being non-suppressed. The age groups below 60+ (APR=0.67) had a higher likelihood of a non-suppressed VL, with the highest in the 0–14 age group (APR=2.38). Clients enrolled at tertiary and secondary level facilities had the greatest likelihood of a non-suppressed VL. Clients who started ART between 2010 and 2015 had the greatest likelihood of viral non-suppression (APR=6.19). A shorter time on ART (<1 year (APR=3.92)) was associated with a higher likelihood of a non-suppressed VL. Clients receiving care at private facilities had a lower likelihood of viral non-suppression in the adjusted model. Clients in the Edo (APR=2.66) and Niger (APR=2.54) states had the greatest likelihood of viral non-suppression.ConclusionsTargeting males, clients of younger age, those on treatment for less than 3 years, clients at tertiary and secondary health facilities, small and medium facilities, and clients in the Edo, Niger and Borno states for interventions could lead to improvements in VL suppression in Nigeria. The independent factors associated with a non-suppressed VL can guide improvements in ART programme development and VL suppression of PLHIV on ART in Nigeria.

Prevalence and factors associated with viral non‐suppression in people living with HIV receiving antiretroviral therapy in sub‐Saharan Africa: A systematic review and meta‐analysis

“…The collective evidence from various studies 27,31,32,34,35,47,49 revealed a statistically significant association between male gender and an increased likelihood of experiencing VNS (AOR: >1, p ‐value <0.05) in the context of HIV. Younger age often exhibits a higher susceptibility to experiencing VNS 10,27,30,49,50 (AOR: >1, 95%, CI: <1 or >1, p ‐value <0.05).…”

“…The collective evidence from various studies 27,31,32,34,35,47,49 revealed a statistically significant association between male gender and an increased likelihood of experiencing VNS (AOR: >1, p ‐value <0.05) in the context of HIV. Younger age often exhibits a higher susceptibility to experiencing VNS 10,27,30,49,50 (AOR: >1, 95%, CI: <1 or >1, p ‐value <0.05). This heightened risk among younger individuals can stem from various factors, including lifestyle dynamics, such as social obligations or employment commitments, which may interfere with treatment adherence.…”

“…Younger individuals managing HIV treatment often struggle with adherence due to factors such as lifestyle demands like education or work, social pressures, concerns about stigma and disclosure, mental health issues and limited health literacy. Several additional factors associated with increased odds of VNS included lower education levels, 30,34 being married or cohabitating status, 43 receiving care at smaller or medium‐sized health facilities 49 or private clinics. Being treated at primary healthcare centers, 27 facing food insecurity, 26 lower household income, 46 residing in rural areas, 45 having a history of extensive external migration 46,50 and residence in HIV incidence hotspots 50 (Supporting Information ).…”

“…Sub‐optimal adherence also heightens the risk of viral mutation, reducing the virus susceptibility to prescribed medication. Duration on ART was also associated with high odds of VNS (AOR: >1, p ‐value <0.05), especially 12 months after being on ART 38,49,52 . PLHIV with a history of or currently experiencing active tuberculosis (TB) infection demonstrated a higher likelihood of having VNS 22,25 .…”

“…Of the included studies, 15 were cross-sectional, 10 were cohort, five were nested studies in clinical trials and two were case-control (Table 1). The majority (29/32) of the studies 10,22,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][49][50][51][52] used a viral load threshold of ≥1000 copies/mL to define VNS.…”