[Incidence and determinants of viral load rebound in people receiving multi-month dispensing of antiretroviral therapy at the Regional Annex Hospital of Dschang from 2018-2023].

Abstract

Introduction: in Cameroon, multi-month dispensing (MMD) of antiretrovirals (ARVs) was introduced to improve treatment adherence among people living with HIV (PLHIV). However, this strategy has limitations that may lead to viral load rebound. The purpose of this study is to assess the incidence and factors associated with viral rebound in PLHIV receiving MMD at the Dschang Regional Annex Hospital between 2018 and 2023.

Methods: we conducted a retrospective cohort study comparing the incidence of viral rebound (increase of over 100 copies/mL after suppression) and its determinants in patients on MMD versus those on monthly dispensing (MD) from January 2018 to December 2023. Data were collected from patients´ medical records using a standardized data collection sheet. Descriptive statistics were followed by bivariate and multivariate analyses to identify factors associated with viral rebound, with a significance threshold of p<0.05.

Results: a total of 519 patients (438 on MMD and 81 on MD) were included. The incidence of viral rebound was 18.8% among patients on MMD compared to 37.8% among those on MD. The male-to-female ratio was 0.53, with the majority of patients aged 30 to 45 years. MMD coverage decreased from 76% in 2018 to 51.02% in 2023. Factors significantly associated with viral rebound included dispensing type (p=0.001), treatment interruption (p=0.001), age group 30-45 years (p=0.001) and tobacco use (p=0.008).

Conclusion: the incidence of viral rebound is higher among patients on MD. Improving the management of PLHIV and promoting healthier lifestyle choices are essential to prevent long-term treatment failure.