Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India

Abstract

Background Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Mé decins Sans Frontières has provided routine VL measurements and EAC to PLHA on ART at King Edward Memorial (KEM) hospital, Mumbai since October-2016. This study aims to describe the initial VL results and impact of EAC on viral suppression and factors associated with initial viral non-suppression among patients with an initial detectable VL, in a cohort of patients tested between October-2016 and September-2018. Methods This is a descriptive study of PLHA on ART who received VL testing and EAC during October-2016 to September-2018. Log-binomial regression was used to identify factors associated with a high VL. Results Among 3849 PLHA who underwent VL testing, 1603(42%) were female and median age was 42 years (IQR:35-48). Majority were referred for routine testing (3432(89%)) and clinical/immunological failure (233(6%)). Overall, 3402(88%) PLHA had suppressed VL at initial testing. Among 3432 tested for routine monitoring, 3141(92%) had VL suppressed. Of 291 with VL>1000c/ml, 253(87%) received EAC and after repeat VL, 70(28%) had VL<1000c/ ml. Among 233 referred for clinical/immunological failure, 122(52%) had VL>1000c/ml and 109 have been switched to second-line ART. CD4 count<500 (aOR-5.0[95%CI 3.8-6.5]), on ART for<5 years (aOR-1.5[1.1-2.0]) and age<15 years (aOR-5.2[3.0-8.9]) were associated with an initial VL>1000c/ml. Factors

Virological failure among HIV infected individuals on antiretroviral therapy in Pune, India: a cross-sectional study

“…12 A recent study showed a virological failure of 12% in Mumbai at the beginning of the viral load monitoring, while a suppression of 92% was observed among the subgroup of PLHIV tested for routine monitoring. 7 Developing countries have reported prevalence ranging from 9% to 13% for virological failure among PLHIV accessing antiretroviral therapy. [13][14][15] This may be attributed to the differences in study design, age groups, duration on ART, drug regimen, treatment adherence, study period and definition of virological failure considered for analysis in all these studies.…”

“…Higher risk of virological failure was observed among men as compared to women similar to a study from western India and other developing countries though few studies have not reported any association. 7,13,15 The reasons for vulnerability of men to virological failure might be due to less healthcare-seeking behaviours and ART uptake, higher body mass index as compared to women which is more likely to maintain a lower concentration of drugs in their bodies than women, and socio culture habits like smoking and drinking which can lead to poorer adherence to medication and virological suppression. [16][17][18][19][20] PLHIV less than 40 year had significant risk of virological failure as found in southern Indian study and Ethiopian population.…”

“…2,3 Though there are many studies on treatment failure by using targeted viral load; there are few studies on virological failure from India after the introduction of routine viral load testing within programme. [5][6][7][8][9] With this background, the current crosssectional study was conducted. The objective of this study was to determine the proportion and factors associated with virological failure among adult PLHIV on first line antiretroviral therapy attending ART centre located in Pune, India.…”

Clinical Outcomes and Retention Among HIV-Infected Adolescents and Adults Initiated on Protease Inhibitors Antiretroviral Therapy Regimen in Dar ES Salaam; A Longitudinal Retrospective Descriptive Study

“…Enhanced adherence intervention was introduced along with HIV viral load monitoring has played a signi cant role to improve virologic outcomes in patients who have high viral loads >1000copies/ml and adherence issues [18,19]. WHO guidelines recommend that patients with HVL>1000copies/ml be subjected to an enhanced adherence support intervention, after which a second viral load test should be performed prior to the decision on con rmed virologic failure and the subsequent ARV regimen [26,27].…”

Virological Outcomes and Risk Factors for Non-suppression for Routine and Repeat Viral Load Testing After Enhanced Adherence Counselling During Viral Load Testing Scale-up in Zimbabwe: Analytic Cross-sectional Study Using Laboratory Data From 2014 to 2018.

“…a 12-month VL is a VL collected between 10 and 14 months). The age variable was categorised into the following ages in years; children (0-9), adolescents (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), young adults (20)(21)(22)(23)(24), adults and elderly (above 50). The outcome of our study was VL suppression.…”