Viral load suppression among HIV-positive adult patients on the first-line antiretroviral treatment regimen in health facilities in the City of Ekurhuleni, Gauteng province, South Africa.

Abstract

Introduction: the Human Immunodeficiency Virus (HIV) remains a global health concern, with South Africa among the hardest hit countries. Viral suppression in HIV patients is a positive treatment outcome when monitoring progress and using antiretrovirals (ART). Despite the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 strategy which focuses on monitoring viral suppression, unsuppressed viral loads keep persisting because of several factors. The study sought to determine viral load suppression and contributing factors among adult patients on first-line ART in Ekurhuleni District, South Africa.

Methods: the study reviewed 379 patient files of adult patients on first-line ART between April and June 2018. Standardized tools were used to collect sociodemographic and clinical data. Descriptive data was analyzed using frequency tabulations and percentages, and multivariable logistic regression was used to identify factors associated with viral load suppression.

Results: the study included 379 patient records. Mean age; DS of 38.9 years with standard deviation at 10.1. The prevalence of viral load suppression at 12 months was 75.2% (n=285). Female participants had higher suppression rates 77.7% (n=188) than males 70.8% (n=97), received pre-ART counseling 73.1% (n=277) as well as no history of tuberculosis 92.4% (n=350). Being female with (aOR=7.29, 95% CI: 1.02 - 52.26; p=0.04) and having completed a six-month viral load assessment (aOR=1.85, 95% CI: 1.00 - 3.41; p=0.04) were independently associated with higher odds of having a suppressed viral load. However, being referred for adherence (aOR=0.61, 95% CI: 0.37 - 0.99; p=0.05) and having a previous history of ART exposure (aOR=0.29, 95% CI 0.10 - 0.77; p=0.01) were independently associated with lower odds of having a suppressed viral load.

Conclusion: a higher suppression rate among female patients, suggests that more targeted interventions should be facilitated among HIV-positive male patients linkage to care and initiated on ART. Exposing the patient to a few enhanced support programs hinders progress toward reducing nonadherence, lack of awareness, and inadequate knowledge about the benefits of achieving viral suppression among people living with HIV.