Non-uptake of viral load testing among people receiving HIV treatment in Gomba district, rural Uganda

Abstract

Background Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. Methods We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6 months after ART initiation and 12 months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). Results Of 414 PWH, 60% were female, and the median age was 40 years (interquartile range [IQR] 31–48). Most (62.3%) had been on ART > 2 years, and the median duration of treatment was 34 months (IQR 14–55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (≤2 years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37–4.12; p = 0.002), younger age 16–30 years (AOR 2.74; 95% CI:1.44–5.24; p = 0.002) and 31–45 years (AOR 1.92; 95% CI 1.12–3.27; p = 0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78–4.56; p < 0.001) were significantly associated with non-uptake of VL testing. Conclusions One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95-95 target – virologic suppression for 95% of PWH on ART.

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

“…We found lower adherence to VL testing than the 95% target [ 4 ]. However, our findings are comparable to what was reported by other studies conducted in sub-Saharan Africa that showed 60% from a population based survey across Uganda [ 13 ], 33% central Uganda [ 10 ], 54% northern Uganda [ 20 ], 32% in South Africa, [ 21 ] and 60% in Mozambique [ 22 ]. However, our mixed methods study design enabled us to explore the contextual factors responsible for poor VL monitoring.…”

“…There is evidence that regular VL monitoring is a cost effective [ 6 ] and is the first choice strategy for identifying poor adherence to ART and detecting treatment failure among PLHIV due to its good specificity and sensitivity [ 7 , 8 ]. However, many PLHIV on ART are still reporting to healthcare facilities with either no evidence of viral load testing or out-of-schedule results [ 9 , 10 ]. This potentially delays detection of treatment failure, identification of patients in need of more intensive adherence support, and results in unnecessary switch to expensive and limited 2 nd and 3 rd line ART regimen options [ 11 ].…”

Viral load monitoring for people living with HIV in the era of test and treat: progress made and challenges ahead – a systematic review

“… 24 months 662/951 (69.6%) - - - Woldesenbet, S. A.; 2021 [ 29 ] 2019 6,542/8,112 (81.7%) - - - - VL testing recommended for all HIV (+) pregnant women at delivery, on ART at 1st ANC visit or 3 months after ART initiation Herce, M.E. ; 2020 [ 50 ] 6 months 269/346 (78%) - - - - IVL: % individuals with completed VL monitoring scheduled at 6- and 12-months follow-up visits 12 months 96/149 (64%) - - - Mshweshwe-Pakela, N.; 2020 [ 30 ] 6 months 455/710 (64.1%) - - - VL test done between 4 and 8 months after ART initiation Nakalega, R.; 2020 [ 47 ] 12 months 279/414 (67.4%) - - - - VL testing done at 6 months after ART initiation and 12 months thereafter at national reference Lab Opito, R.; 2020 [ 48 ] 12 months 221/422 (52.4%) - - - VL monitoring assessed by the presence of VL slip captured in medical record within 12 months of enrolment on test and treat Ya, S.S.T. ; 2020 [ 53 ] 6 months 952/1,892 (50.3%) 88/106 (83%) 23/88 (26%) …”

Viral Load suppression after intensive adherence counselling among HIV infected adults at Kiswa Health Centre, Kampala: A retrospective cohort study. Secondary data analysis

“…A retrospective cohort study in rural Uganda in 2017 found that 19% of 411 PWHIV with an unsuppressed VL did not receive IAC [37] while another earlier retrospective review conducted at 15 Uganda public health centers from June 2015 to December 2016 found that 7% of 449 study participants with VL above 1000 copies/ml did not have any IAC session provided [16]. This improvement in IAC linkage re ects the increased efforts by Ministry of Health in Uganda which is geared towards increased routine HIV VL testing to quickly refer for the IAC intervention all PWHIV identi ed to have unsuppressed VL [13].…”