A Retrospective Medical Record Review on the Outcome of Enhanced Adherence Counseling among Unsuppressed HIV Clients in Benue State, Nigeria

Background: According to the WHO estimation, up to 70 % of patients with an initial high viral load will achieve viral load suppression following an adherence intervention. In Benue State, very limited studies have been done that show viral load suppression following enhanced adherence counselling (EAC). This study assesses viral suppression after enhanced adherence counselling and its predictors among unsuppressed HIV seropositive people in the State, the time to commence EAC after the unsuppressed VL result, and to estimate the time to repeat the viral load test after EAC. Methods: This was a retrospective review of electronic medical records of all HIV-infected people with a viral load greater than 1000 copies/ml after six months on HAART as of December 2022, in Benue State. Patients with VL ≥ 1000 copies/ml were expected to receive EAC and have a repeat VL after three months of good adherence. Six months following the documented unsuppressed result, we determined: the viral load suppression rate after EAC, the time to commencement of EAC, the time to repeat the viral load test after EAC, and the predictors of viral load suppression among clients with unsuppressed viral load. Result: Of the 234,185 People Living with HIV (PLHIV) on ART between December 2022 and July 2023, up to 210, 514 (89.9%) did viral load testing and 9194 (3.9%) had VL >1000 copies/ml. Of these 9,194 unsuppressed PLHIV, EAC uptake was 90.3% (n=8,307), EAC completion rate was 62.5% (n=5,220), and viral suppression rate following EAC was 93.8% (4897/5220). PLHIV who have been on treatment for less than five years were more likely to achieve viral load suppression. Conclusion: The study demonstrated a post-EAC viral load re-suppression rate of 93.8%, indicating significant effectiveness. Nonetheless, notable deficiencies were observed in both EAC enrollment and completion. It is imperative to identify and address the underlying reasons for these gaps to fully optimize the benefits of Enhanced Adherence Counseling (EAC).