HIV viral load suppression following intensive adherence counseling among people living with HIV on treatment at military-managed health facilities in Uganda

Kikaire, Bernard; Ssemanda, Michael; Asiimwe, Alex; Nakanwagi, Miriam; Rwegyema, Twaha; Seruwagi, Gloria; Lawoko, Stephen; Asiimwe, Evarlyne; Wamundu, Cassette; Musinguzi, Ambrose; Lugada, Eric; Turesson, Elizabeth; Laverentz, Marni; Bwayo, Denis

doi:10.1016/j.ijid.2021.08.057

Cited by 14 publications

(7 citation statements)

References 26 publications

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“…This was comparable to other studies. [32][33][34][35] Poor adherence to HAART has been highly linked to the development of drug resistance among PLHIV, [36][37][38][39] and this drug resistance leads to virological non-suppression as HIV replication is not well suppressed, which, in turn, leads to an increase in the viral load. [40][41][42] This shows the importance of continuous adherence monitoring and counseling among PLHIV.…”

Section: Discussionmentioning

confidence: 99%

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

Kabiibi,

Tamukong,

Muyindike

et al. 2024

HIV

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kabiibi,

Tamukong,

Muyindike

et al. 2024

HIV

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“…However, this finding remains consistent with numerous other studies that have shown a low effectiveness of IAC in causing viral re-suppression among non-suppressed people living with HIV. For instance, a Ugandan study found that only 23% of paediatric patients with HIV achieved viral suppression after IAC [46]; another Ugandan study evaluated the outcomes of IAC in improving viral suppression and found that 48.2% of participants with HIV achieved viral suppression following IAC [47]; and in Zimbabwe, 31.2% of participants with HIV who underwent a repeat VL after IAC achieved VL suppression [48]. This low success rate of IAC could be due to various challenges affecting the implementation of IAC, including clients missing IAC sessions, shortage of food, stigma and discrimination, delayed VL results, a lack of incentives, and heavy workloads, among others [46,49].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low‐level viraemia in Uganda

Nanyeenya,

Nakanjako,

Makumbi

et al. 2023

HIV Medicine

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IntroductionUganda was using a threshold of 1000 copies/mL to determine viral non‐suppression for antiretroviral therapy monitoring among people living with HIV, prior to this study. It was not clear whether people living with HIV with low‐level viraemia (LLV, ≥50 to <1000 copies/mL) would benefit from intensive adherence counselling (IAC). The purpose of this study was to determine the effectiveness of IAC among people living with HIV, receiving antiretroviral therapy, and with LLV in Uganda, to guide key policy decisions in HIV care, including the review of the viral load (VL) testing algorithm.MethodsThis cluster‐randomized clinical trial comprised adults from eight HIV clinics who were living with HIV, receiving ART, and had recent VL results indicating LLV (tested from July 2022 to October 2022). Participants in the intervention arm clinics received three once‐monthly sessions of IAC, and those in the comparison non‐intervention arm clinics received the standard of care. At the end of the study, all participants were re‐tested for VL to determine the proportions of those who then had an undetectable VL (<50 copies/mL). We assessed the statistical association between cross‐tabulated variables using Fisher's exact test and then modified Poisson regression.ResultsA total of 136 participants were enrolled into the study at eight HIV clinics. All 68 participants in the intervention arm completed all IAC sessions. Only one participant in the non‐intervention arm was lost to follow‐up. The average follow‐up time was 3.7 months (standard deviation [SD] 0.2) and 3.5 months (SD 0.1) in the intervention and non‐intervention arms, respectively.In total, 59 (43.7%) of 135 people living with HIV achieved an undetectable VL during the study follow‐up period. The effect of IAC on attaining an undetectable VL among people with LLV was nearly twice as high in the intervention arm (57.4%) than in the non‐intervention arm (29.9%): adjusted risk ratio 1.9 (95% confidence interval 1.0–3.5), p = 0.037.ConclusionIAC doubled the likelihood of an undetectable VL among people living with HIV with LLV. Therefore, IAC has been instituted as an intervention to manage people living with HIV with LLV in Uganda, and this should also be adopted in other Sub‐Saharan African countries with similar settings.ClinicalTrials.Gov IdentifierNCT05514418.

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“…Like elsewhere [ 22 , 23 ], studies have been conducted in Uganda to assess implementation of IAC from the lens of the health care providers (family and health workers) [ 11 , 24 , 25 ], and PLHIV [ 26 , 27 ]. In this study we focused on the healthcare providers and explored the barriers to the utilization of the UMOH IAC framework in order to identify potential solutions that may be more broadly applicable and feasible [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to the utilization of the intensive adherence counselling framework by healthcare providers in Uganda: a qualitative study

Musinguzi

Najjuma

Arishaba

et al. 2022

BMC Health Serv Res

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Background Uganda Ministry of Health (UMOH) embraced the World Health Organization recommendation for people living with human immunodeficiency virus with a detectable viral load (VL) exceeding 1000 copies/mL to receive intensive adherence counselling (IAC). The IAC framework was developed as a step-by-step guide for healthcare providers to systematically support persons with non-suppressed VL to develop a comprehensive plan for adhering to treatment. The objective of this study was to explore the current practice of the healthcare providers when providing IAC, and identify the barriers and facilitators to the utilization of the UMOH IAC framework at two health centers IV level in rural Uganda. Methods This was a descriptive cross-sectional qualitative study that explored the current practices of the healthcare providers when providing IAC, and identified the barriers and facilitators to the utilization of the UMOH IAC framework. We used an interview guide with unstructured questions about what the participants did to support the clients with non-suppressed VL, and semi-structured questions following a checklist of categories of barriers and facilitators that affect ‘providers of care’ as provided by the Supporting the Use of Research Evidence for policy in African health systems (SURE) framework. Current practice as well as the categories of barriers and facilitators formed the a priori themes which guided data collection and analysis. In this study we only included healthcare providers (i.e., medical doctors, clinical officer, nurses, and counsellors) as ‘providers of care’ excluding family members because we were interested in the health system. Results A total of 19 healthcare providers took part in the interviews. The healthcare providers reported lack of sufficient knowledge on the UMOH IAC framework; most of them did not receive prior training or sensitization when it was first introduced. They indicated that they lacked counselling and communication skills to effectively utilize the IAC framework, and they were not motivated to utilize it because of the high workload at the clinics compounded by the limited workforce. Conclusions Although the UMOH IAC framework is a good step-by-step guide for the healthcare providers, there is need to understand their context and assess readiness to embrace the new behavior before expecting spontaneous uptake and utilization.

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HIV viral load suppression following intensive adherence counseling among people living with HIV on treatment at military-managed health facilities in Uganda

Cited by 14 publications

References 26 publications

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

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

Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low‐level viraemia in Uganda

Barriers and facilitators to the utilization of the intensive adherence counselling framework by healthcare providers in Uganda: a qualitative study

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