ENHANCED ADHERENCE COUNSELLING AND VIRAL LOAD SUPPRESSION AMONGST PEOPLE LIVING WITH HIV (PLHIV) IN A GOVERNMENT HOSPITAL IN RIVERS STATE, NIGERIA.

Abstract

Background: Antiretroviral therapy (ART) remains the primary treatment for Human immunodeficiency virus (HIV) infection, aiming to reduce viral replication and mortality, but this requires lifelong adherence. To achieve viral load suppression [VLS] (below 1000 copies/ml), the World Health Organization (WHO) recommends annual viral load measurements and enhanced adherence counseling (EAC).

Objectives: This study aims to determine the prevalence of VLS following EAC amongst the virally unsuppressed PLHIV at the Rivers State University Teaching Hospital (RSUTH) and the factors influencing their virology outcomes.

Methods: A retrospective descriptive review of records of 330 virally unsuppressed PLHIV from September 2021-March 2023 at RSUTH. Sampling method: Random sampling method (table of random numbers and selecting the assigned ones till the sample size was achieved), of non-pregnant, PLHIV, aged 18 years and above with VLs >1,000 copies/ml after at least 6 months on ART and a comprehensive 3 sessions of monthly EAC support programme after which viral load estimations were done on the 4th month after EAC, to assess outcomes. Ethical approval was obtained from the RSUTH ethical committee and informed consent was received from the ART management team. Data was collated, and associations were analysed with statistical significance set at a p-value of ≤0.05 .

Results: The prevalence of VLS after EAC3 (three sessions) was 70.9%. Higher preponderances were recorded among the females (51.5%), middle-aged (73.3%), unemployed (71.1%), those on first-line ART regimen (71.3%), CD4 3 count of <200cells/mm , and statistically significant levels in those with < five years antiretroviral treatment (79.5%) with X2 = 19.418, p-value = 0.000. There were also significant logistic regression scores (4.119, p =0.042 and 41.173, p =0.000, respectively) for VLS levels after EAC2 and EAC3. Participants with an initial VL of <100,000 copies/ml recorded the highest VLS of 71.8.

Discussion: The viral load suppression rate of 70.9% after EAC3, observed in this study is consistent with results from several similar studies across sub-Saharan Africa ranging from 66.4% to 74%. This signifies a good uptake of the EAC by patients as well as good interventional outcomes.

Conclusion: Strict administration of EAC for at least three sessions with viral load monitoring is helpful in achieving viral suppression and contributes to achieving the UNAIDS 95-95-95 goals in PLHIV in Nigeria and should be intensified. Keywords: Antiretroviral therapy, Enhanced adherence counseling, Viral load suppression.