Barriers to viral load suppression among adolescents living with HIV on anti-retroviral therapy: a retrospective study in Tanga, Tanzania

BACKGROUND

Despite the decreased incidence of the human immunodeficiency virus (HIV) in Tanzania, the number of adolescents living with HIV is increasing. This study aimed to describe factors independently associated with viral load non-suppression among adolescents living with HIV (ALHIV) on ART in the Tanga region.

METHODS

We conducted a retrospective study of routinely collected data from ALHIV on ART from October 2018 to April 2022. We extracted data from the Care and Treatment Clinics form number 2 (CTC2) database that included age, sex, BMI, World Health Organization HIV clinical disease stage, marital status, ART duration, viral load suppression, facility level, and Dolutegravir (DTG)-based regimen. We did descriptive analysis using frequencies to describe the study participants' socio-demographic and clinical characteristics. The Cox proportional hazard regression model was used to identify factors associated with viral load non-suppression (VLS). Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. A total of 4735 ALHIV on ART were extracted from CTC2, then 2485 were excluded (2186 missed viral load results, 246 were lost to follow-up, and 53 deaths).

RESULTS

2250 ALHIV on ART were tested for viral load, of whom 2216 (98.62%) adolescents were on first-line ART, and 2024 (89.96%) participants were virally suppressed, while 226 (10.04%) were virally non-suppressed. In addition, 2131 (94.71%) of participants were using a DTG-based regimen; of them, 1969 (92.40%) were virally suppressed. Not using a DTG-based regimen (HR: 9.36, 95% CI 3.41-15.31) and dispensary facility level (HR: 3.61, 95% CI 1.44-7.03) were independently associated with increased hazard for viral load non-suppression. In addition, adolescents aged between 15 and 19 years are less likely to be virally suppressed (HR: 0.55, 95% CI 0.30-0.99).

CONCLUSIONS

The dispensary facility level and not using a DTG-based regimen were significantly associated with viral load non-suppression. HIV intervention strategies should ensure a DTG-based regimen utilization in all adolescents living with HIV, and techniques used by higher-level health facilities should be disseminated to lower-level facilities.

Determinants of viral load suppression failure among HIV adults on ARV attending health care facilities: a retrospective study in Tanga region, Tanzania

BACKGROUND

Availability and accessibility of Antiretroviral drugs (ARV's) improve the lives of People living with HIV (PLHIV) by improving client's immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels.

METHODS

A retrospective longitudinal study design study was conducted from 1st October, 2018 to 30th June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load <1,000 HIV RNA copies/ml (viral load suppression). Cox proportional hazard regression models were employed to identify risk factors for virological failure. P values were two-sided, and we considered a P<0.05 to be statistically significant.

RESULTS

Fifty-nine thousand five hundred three adult clients >15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - <25 years (HR: 2.82, 95% CI 1.96 - 4.04), BMI <18.5 (HR: 1.69, 95% CI 1.23 - 2.30), advanced WHO stage IV (HR: 1.60, 95% CI 1.12 - 2.24), CD4 cell count <350 (HR: 2.61, 95% CI 2.12 - 3.23), poor adherence (HR: 1.98, 95% CI 1.80 - 2.18) and not using DTG based drug (HR: 11.8, 95% CI 9.74 - 14.3).

CONCLUSION

Virologic failure was observed in this study among clients with young age, advanced WHO stage IV, not using DTG based regimen, poor drug adherence and second line regime. To improve Viral Load Suppression among these clients; the existing HIV intervention strategies should be taken care by targeting the identified risk factors.

Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study

We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs.

Risk factors for unsuppressed viral load after intensive adherence counseling among HIV infected persons in Kampala, Uganda: a nested case-control study

BACKGROUND

Intensive adherence counseling (IAC) is the global standard of care for people living with human immunodeficiency virus (PLHIV) who have unsuppressed VL after ≥ 6 months of first-line anti-retroviral therapy (ART). We investigated whether the number of IAC sessions is associated with suppressed VL among PLHIV in Kampala, Uganda.

METHODS

We conducted a nested case-control study among PLHIV with unsuppressed VL after ≥ 3 IAC sessions (cases) and a 2:1 random sample of PLHIV with suppressed VL after ≥ 3 IAC sessions (controls). Unsuppressed VL was defined as VL ≥ 1000 copies/ml. We performed multivariable logistic regression to identify factors that differed significantly between cases and controls.

RESULTS

Demographic and clinical characteristics were similar among the 16 cases and 32 controls including mean age, sex, baseline CD4 count, VL before IAC, and WHO clinical stage. Only the number of IAC sessions differed significantly between cases and controls in unadjusted (p = 0.012) and adjusted (p = 0.016) analyses. Each unit increase in IAC session was associated with unsuppressed VL (Adjusted odds ratio 5.09; 95% CI 1.35-19.10).

CONCLUSIONS

VL remained unsuppressed despite increasing IAC frequency. The fidelity to standardized IAC protocol besides drug resistance testing among PLHIV with unsuppressed VL before IAC commencement should be examined.

Dataset evaluating the effectiveness of the Konga model to address factors contributing to a low viral load suppression among children with HIV in Tanzania

Data were collected for a cluster-randomized clinical trial of the Konga community-based intervention using a validated questionnaire for children and caregivers. The raw and analyzed data include 82 participants with the following information: sociodemographic characteristics (caregiver's age, sex, and level of education, income, and caregiver's marital status) and clinical characteristics of the children (weight, CD4 cell count, and viral load at baseline and after 6 months of follow-up. The other data included in this dataset were weight, medication adherence, and opportunistic infections. Analysis of covariance (ANCOVA) was performed using the baseline VL. The outcome was viral load at the end of the intervention. Additionally, Omega squared (ω2) was used to calculate the effect size as an estimation of the strength of the intervention. These data will help researchers analyze data from similar studies and evaluate the effectiveness of community-based interventions for viral load suppression.

The clinical impact of rifampicin-based anti-TB therapy and tenofovir alafenamide-containing ARV regimen drug Interaction in people living with HIV: Case series report

BACKGROUND

People living with HIV (PLWH) are prone to developing tuberculosis (TB). Since tenofovir alafenamide (TAF) is the recommended tenofovir (TFV) prodrug and rifampicin is a key component of TB therapy, thus complicating HIV and TB coinfection management. However, there is little data regarding the impact of this drug-drug Interaction in PLWH, which makes health care providers reluctant to prescribe them together.

METHODS

This was an observational, retrospective case series carried out at King Faisal Specialist Hospital & Research Center (KFSH&RC), Jeddah, Saudi Arabia. PLWH (≥18 years old) who received the TAF-containing ARV regimen and rifampicin-based anti-TB therapy together for ≥ 4 weeks were included. The objective of this study was to report the clinical impact of this drug-drug interaction (rifampicin + TAF-containing antiretroviral (ARV) regimen) on HIV viral load control in PLWH.

RESULTS

A total of 7 PLWH who met the inclusion criteria, 5 (71 %) out of 7, were males. All patients received dolutegravir 50 mg twice daily (DTG) plus the combination of TAF 25 mg and emtricitabine 200 mg (FTC) once daily as their ARV regimen. Four patients had suppressed viral load levels at baseline, which was maintained throughout TB treatment. Three patients had unsuppressed viral load levels at baseline and attained viral load suppression throughout the TB treatment course CONCLUSION: Overall, the TAF-containing ARV regimen maintained it's efficacy in presence of rifampicin.

Identifying longitudinal patterns of HIV treatment (dis)engagement and re-engagement from oral histories of virologically unsuppressed persons in Uganda: A thematic trajectory analysis

BACKGROUND

There is limited study of persons deemed "harder to reach" by HIV treatment services, including those discontinuing or never initiating antiretroviral therapy (ART). We conducted narrative research in southern Uganda with virologically unsuppressed persons identified through population-based sampling to discern longitudinal patterns in HIV service engagement and identify factors shaping treatment persistence.

METHODS

In mid-2022, we sampled adult participants with high-level HIV viremia (≥1000 RNA copies/mL) from the prospective, population-based Rakai Community Cohort Study. Using life history calendars, we conducted initial and follow-up in-depth interviews to elicit oral histories of participants' journeys in HIV care, from diagnosis to the present. We then used thematic trajectory analysis to identify discrete archetypes of HIV treatment engagement by "re-storying" participant narratives and visualizing HIV treatment timelines derived from interviews and abstracted clinical data.

RESULTS

Thirty-eight participants (median age: 34 years, 68% men) completed 75 interviews. We identified six HIV care engagement archetypes from narrative timelines: (1) delayed ART initiation, (2) early treatment discontinuation, (3) treatment cycling, (4) prolonged treatment interruption, (5) transfer-related care disruption, and (6) episodic viremia. Patterns of service (dis)engagement were highly gendered, occurred in the presence and absence of optimal ART adherence, and were shaped by various factors emerging at different time points, including: denial of HIV serostatus and disclosure concerns; worsening HIV-related symptoms; psychological distress and depression; social support; intimate partner violence; ART side effects; accessibility constraints during periods of mobility; incarceration; and inflexible ART dispensing regulations.

CONCLUSIONS

Identified trajectories uncovered heterogeneities in both the timing and drivers of ART (re-)initiation and (dis)continuity, demonstrating the distinct characteristics and needs of people with different patterns of HIV treatment engagement throughout the life course. Enhanced mental health service provision, expanded eligibility for differentiated service delivery models, and streamlined facility switching processes may facilitate timely (re-)engagement in HIV services.

Sustained Retention, Viral Load Suppression and their Determinants Among Clients on HAART Enrolled Under Differentiated Service Delivery Models in Eastern Uganda

Background

Although Uganda rolled out Differentiated Service Delivery(DSD) models in June 2017 to improve retention and viral load suppression rates among clients on Highly Active Antiretroviral Therapy (HAART), these have remained low relative to the Joint United Nations Programme on HIV/AIDS(UNAIDs) targets of achieving 95% population with HIV tested, 95% of tested positive clients for HIV to be on Highly active Antiretroviral therapy and 95% of clients On Antiretroviral therapy be suppressing by 2030(95-95-95 UNAIDS targets). The purpose of this study was to determine sustained retention, viral load suppression and their determinants among clients on HAART enrolled under different Differentiated service delivery models in Katakwi district in Eastern Uganda.

Methods

A retrospective cohort study of clients enrolled on HAART in the different approaches of DSD who were active by 2017 and followed up to 2020 was done. The primary outcomes included sustained retention, viral load suppression and their determinants among clients HAART in different DSD approaches. Eight health facilities providing HAART services were purposively sampled and 771 clients on HAART were sampled out by simple random selection from a total population of 4742 clients on HAART in Katakwi district. We analysed retention, viral load suppression rates, and their determinants by logistic regression method using STATA.

Results

A total of 771 participants were sampled of whom 42.7% were male and 57.3% were female, with the mean age being 40 years. Retention rates at 95% CI of participants were 99.35% at 12 months, 94.03 at 24 months, 89.88% at 36 months and 84.57% at 48 months. The viral load suppression rates were 57.3% at 12 months, 70.3% at 24 months, 70.3% at 36 months and 69% at 48 months. Retention was higher in the community based DSD model as compared to the facility-based model. Viral load suppression was higher in the community based DSD models in which Community Drug Distribution Points had the highest achievement (92%) followed by Community Client-Led ART Distribution (79%) compared to the facility based DSD models in which Facility Based Individual Management performance (34.3%) was far below the set standard of 95%, followed by Facility Based Groups (65%) with Fast Track Drug Refill having relatively better performance (80.9%). Being 40-59 years, receiving care from the general hospital, being married, having good current adherence, being on the first line of the current regime and being a female are other predictors of viral load suppression, whereas being 40-59 years of age, having good current adherence, being on the current first-line regime and having no co-morbidities were predictors of good retention.

Conclusions

generally, facility and community based DSD models have demonstrated improved retention and viral load suppression. However, community-based models have shown to be more effective than facility-based models through mitigation of barriers to effective HIV/AIDS care of clients on HAART. Viral load suppression remained below the UNAIDs target of 95% by 2030, albeit it improved over time.

HIV viral load suppression among people with mental disorders at two urban HIV clinics in Uganda: a parallel convergent mixed methods study using the social ecological model

BACKGROUND

Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda.

METHODS

We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data.

RESULTS

Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0 - 92.2%) achieved VLS. Age (aPR = 1.00, 95%Cl = 1.00-1.00), male gender (aPR = 0.90, 95%Cl = 0.82-0.98), divorced (aPR = 0.88, 95%Cl = 0.82-0.94), widowed (aPR = 0.84, 95%Cl = 0.83-0.86), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.85-0.94), psychotic mental disorders (aPR = 1.11; 95%CI = 1.08-1.13) and fair (85-94%) ART adherence level (aPR = 0.69, 95%Cl = 0.55-0.87) and TDF/3TC/DTG (aPR = 0.92; 95%CI = 0.91-0.94) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS.

CONCLUSION AND RECOMMENDATIONS

HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.

Effectiveness of a community-based intervention (Konga model) to address factors contributing to low viral load suppression among children living with HIV in Tanzania: a preliminary, cluster, randomized clinical trial report

BACKGROUND

Despite effective antiretroviral therapy (ART) coverage in other groups living with human immunodeficiency virus (HIV) in Tanzania, virologic suppression among HIV-positive children receiving ART remains unacceptably low. This study evaluated the effectiveness of a community-based intervention (Konga model) in addressing the factor contributing to low viral load suppression among children living with HIV in the Simiyu region, Tanzania.

METHODS

This study used a parallel cluster randomized trial. The cluster was only eligible if the health facility provided HIV care and treatment. All eligible resident children aged 2‒14 years who attended the cluster with a viral load > 1,000 cells/mm were enrolled. The intervention included three distinct activities: adherence counseling, psychosocial support, and co-morbidity screening such as tuberculosis. The evaluation was based on patient-centered viral load outcomes measured at baseline and 6 months later. Using a pre- and post-test design, we compared the means of participants in the intervention and control groups. We performed an analysis of covariance. The effect of a Konga was calculated using omega-squared. We used F-tests, with their corresponding p-values, as measures of improvement.

RESULTS

We randomly assigned 45 clusters to the treatment (15) and control (30) groups. We enrolled 82 children with amedian age of 8.8 years(interquartile range(IQR);5.5-11.2), and a baseline median viral load of 13,150 cells/mm (interquartile range (IQR);3600-59,200). After the study, both children in each group had good adherence, with children in the treatment group scoring slightly higher than those in the control group, 40 (97.56%) versus 31(75%61), respectively. At the end of the study, the difference in viral load suppression between the two groups was significant. The median viral load suppression at the end of the study was 50 cells/mm [IQR, (20-125)]. After adjusting for the viral load before the intervention, the effect size of the Konga intervention explained 4% (95% confidence interval [0%, 14.1%]) of the viral load variation at the end of the intervention.

CONCLUSION

The Konga model demonstrated significant positive effects that improved viral load suppression. We recommend implementing the Konga model trial in other regions to improve the consistency of results.

Determinants of nonsuppression of HIV viral load among children receiving antiretroviral therapy in the Simiyu region: a cross-sectional study

BACKGROUND

Despite substantial antiretroviral therapy (ART) coverage among individuals with human immunodeficiency virus (HIV) infection in Tanzania, viral load suppression (VLS) among HIV-positive children receiving ART remains intolerably low. This study was conducted to determine factors affecting the nonsuppression of VL in children with HIV receiving ART in the Simiyu region; thus, an effective, sustainable intervention to address VL nonsuppression can be developed in the future.

METHODS

We conducted a cross-sectional study including children with HIV aged 2-14 years who were currently presenting to care and treatment clinics in the Simiyu region. We collected data from the children/caregivers and care and treatment center databases. We used Stata™ to perform data analysis. We used statistics, including means, standard deviations, medians, interquartile ranges (IQRs), frequencies, and percentages, to describe the data. We performed forward stepwise logistic regression, where the significance level for removal was 0.10 and that for entry was 0.05. The median age of the patients at ART initiation was 2.0 years (IQR, 1.0-5.0 years), and the mean age at HIV VL (HVL) nonsuppression was 8.8 ± 2.99 years. Of the 253 patients, 56% were female, and the mean ART duration was 64 ± 33.07 months. In multivariable analysis, independent predictors of HVL nonsuppression were older age at ART initiation (adjusted odds ratio [AOR] = 1.21; 95% confidence interval [CI] 1.012-1.443) and poor medication adherence (AOR, 0.06; 95% CI 0.004-0.867).

CONCLUSIONS

This study showed that older age at ART initiation and poor medication adherence play significant roles in HVL nonsuppression. HIV/AIDS programs should have intensive interventions targeting early identification, ART initiation, and adherence intensification.

Viral load suppression in HIV-infected adolescents in cameroon: towards achieving the UNAIDS 95% viral suppression target

BACKGROUND

Achieving the UNAIDS 95% sustained viral suppression (VS) rate requires considerable global efforts, particularly among adolescents living with HIV (ALHIV) who are often associated with high rates of virological failure (VF). In this study, we prospectively assessed the rate of VS, and the factors associated with VF in a cohort of adolescents followed up according to the WHO guidelines in Cameroon.

METHODS

A cross-sectional study was carried out in 2021 among adolescents (aged 10-19 years) receiving ART in the national program in Cameroon. Socio-demographic and clinical data were collected using patients' medical files and a brief interview with the participant and/or his guardian. Thereafter, a first viral load test (VL1) was performed using the ABBOTT Platform. For adolescents with VL1 > 1000 copies/ml, adherence-enhancing interventions were routinely performed each month for 3 consecutive months, after which a second viral load (VL2) was measured. Adolescents with VL2 > 1000 copies/ml were considered in VF.

RESULTS

Overall, 280 adolescents were enrolled, of whom 89.3% (250/280) acquired HIV infection via mother-to-child transmission. The median age was 16.0 (IQR: 13.0-18.0) years and the median duration on ART was 9.8 (IQR: 5.1-12.8) years. Females and males were almost equally represented, as 52.1% (146/280) were female, while 47.9% (134/280) were males (p = 0.47). The VS rate was 88.2% (CI: 83.8-91.7%) overall; 89.0% (CI: 82.0-93.1%) and 88.7% (CI: 81.2-93.0%) in females and males, respectively. Being on second or third-line ART, self-declared suboptimal adherence, and a history of past VF were independently associated with VF.

CONCLUSION

The high rate of VS we report in this study is welcome in the era of the 95/95/95 UNAIDS goals, and indicates that improving treatment outcomes in this specific and fragile population that represent adolescents in Sub-Saharan Africa is achievable.

TRIAL REGISTRATION

20/10/2020 NCT04593979 ( https://clinicaltrials.gov/ct2/show/NCT04593979 ).

Hepatitis B and C viral coinfections and their association with HIV viral load suppression among HIV-1 infected patients on ART at Mekelle hospital, northern Ethiopia

BACKGROUND

Although Ethiopia is endemic to viral hepatitis and HIV, data that could guide population-specific interventions are limited. In this study, we determined the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and assessed their associations with HIV-1 viral load suppression among HIV-1 infected patients on antiretroviral therapy (ART) at Mekelle hospital in northern Ethiopia.

METHODS

Between February and April 2020, blood samples were collected from 439 participants. Samples were screened for HBsAg and anti-HCV on the immunochromatographic test and confirmed using the Enzyme-Linked Immuno-sorbent assay (Beijing Wantai Co. China). HIV-1 viral load was quantified using reverse transcription-polymerase chain reaction (RT-PCR) on the Abbott platform. Binary and multivariable logistic regression was performed to identify potential predictors.

RESULTS

Overall, 10% (44/439) and 3.6% (16/439) of the participants were coinfected with HBV and HCV, respectively. In a multivariate analysis, being illiterate (AOR = 6.57; 95% CI 1.04-41.6), and having a history of sexually transmitted infections (AOR = 4.44; 95% CI 1.31-15.0) and multiple sexual partners (AOR = 29.9; 95% CI 7.82-114.8) were associated with HBV infection. On the other hand, participants with a history of chronic non-communicable diseases (AOR = 10.6, 95% CI 1.61-70.1), and those reporting a history of sexually transmitted infections (AOR = 5.21, 95% CI 1.39-19.5) were more likely to be infected with HCV. In further analysis, HCV infection status was significantly associated with decreased viral load suppression rate (AOR = 7.14; 95% CI 2.18-23.3) whereas no significant association was observed with the HBV infection.

CONCLUSIONS

The HBV coinfection rate in our study is high and, as per WHO's standard, corresponds to a hyperendemic level. The HCV coinfection rate is also substantially high and urges attention given its influence on the viral load suppression of HIV patients on ART at our study site. Our findings suggest the need to adopt universal screening and vaccination of people with HIV against HBV and screening for HCV at our study site and in Ethiopia at large, which contributes to Ethiopia's progress towards the 2030 global target of reducing the HBV infection.

Characterizing Ryan White Part A-funded support service utilization patterns and their association with viral suppression among people with HIV in New York City

Use of HIV-related support services has been demonstrated to improve outcomes for people living with HIV. Further exploring patterns of use could help identify how and in what settings additional HIV care and treatment adherence support could be provided. We aimed to identify support service utilization patterns and examine their association with viral load suppression (VLS). Our sample comprised 6,581 people with HIV who received Ryan White Part A support services for basic needs (food and nutrition, legal, harm reduction, housing services) in New York City from 1/2013 to 12/2016, but had not received services specifically targeting HIV care and treatment adherence. Five support service utilization classes were identified using latent class analysis, the majority of which were characterized by the predominant use of concrete services (e.g., food assistance). Compared with the low-intensity, sporadic concrete service use class, clients in all other classes had lower odds of VLS in a 365-day follow-up period, but this disadvantage disappeared with adjustment for confounding variables indicative of need. Our findings underscore the impact of need-related barriers on VLS and suggest that long-term service utilization beyond the one year period of this study may be required to diminish their negative effect on HIV outcomes.

Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa

This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.

Association between depression and HIV treatment outcomes in a US military population with HIV infection

Background

Depression is common among HIV-infected individuals and may contribute to suboptimal adherence to antiretroviral therapy (ART) and subsequent inability to attain viral load (VL) suppression. We evaluated associations between depression, self-reported adherence, and longitudinal HIV treatment outcomes in US Military HIV Natural History Study (NHS) participants with and without depression.

Methods

Male NHS participants with available ICD-9 data for mental health diagnoses, Center for Epidemiological Studies Depression (CES-D) measures, and self-reported adherence (SRA) were included. ART use was defined as ART initiation between 2006 and 2010, with follow-up through 2015. SRA was defined as taking 95% of ART doses and continuous ART was defined as longitudinal ART use with gaps  < 30 days. Continuous VL suppression was defined as maintaining VLs  < 200 c/mL on ART. To analyse the association between depression and HIV treatment outcomes, latent class analysis was used to create classes of depression trajectories: low depression (LD), recent onset depression (ROD) and high Depression (HD).

Results

Participants had a mean age of 32 (± 8.3) years at HIV diagnosis, and similar proportions were Caucasian (44.3%) or African American (40.8%). Overall, older participants at HIV diagnosis had greater odds of having 95% self-reported adherence (OR 1.06, 95% CI 1.02–1.12), and African Americans had lower odds (OR 0.41, 95% CI 0.22–0.76) compared to Caucasians (OR 1.49, 95% CI 0.52–4.28). However, there was no difference in SRA by depression trajectory. Participants with HD had an increased odds of taking ART continuously (OR 1.75, 95% CI 0.99–3.09), and those with ROD had significantly higher odds of virologic failure (OR 0.58, 95% CI 0.38–0.91).

Conclusions

Although there was no observed association between depression and SRA, participants with ROD had lower odds of attaining the HIV treatment goal of VL suppression. Continued efforts to identify and aggressively manage mental health disorders is important to success along the HIV care continuum.

Viral load Suppression and Associated Factors among HIV Patients on Antiretroviral Treatment in Bulambuli District, Eastern Uganda: A Retrospective Cohort Study

BACKGROUND

HIV viral load suppression (VLS) is the most important indicator of successful antiretroviral therapy. In 2016, Bulambuli District started monitoring HIV patients on ART using viral load tests in an effort to meet the third 90 of the UNAIDS 90-90-90 strategy which is VLS. The objective of this study was to determine the progress in Bulambuli District towards achievement of VLS among HIV infected patients on ART and associated factors that affect this programme.

METHODS

A retrospective cohort study design was used. One thousand, one hundred and one medical records of HIV infected patients on ART who attended HIV clinic at Muyembe Health Centre IV from June 2016 to April 2018 were reviewed. A data abstraction tool was used for data collection. Chi Square was used to determine factors associated with VLS and logistic regression was used to determine the magnitude by which the ART and clinical factors influence VLS. Data were summarized using descriptive statistics for categorical variables and by computing proportions, means and standard deviation for continuous variables.

RESULTS

Of the patients (n = 944, 85.7%) had attained VLS. Adjusting for known confounders, only adherence to ART was a significant predictor of VLS. Individuals with fair adherence (80%-95%) had 2.667 times the odds of VLS, CI = 1.122-9.370, P-value of <.002 compared to individuals with good (>95%) adherence which was used as the reference while those with poor (<80%) adherence had 4.553 times the odds of attaining VLS, CI = 1.31-13.930, P-value of <.001 compared to individuals with good adherence.

CONCLUSION

These findings suggest that Bulambuli District, at 85.7% VLS is on track to attaining the third 90 of the 90, 90, 90 global targets by 2020. It further reveals that adherence is the only significant predictor of VLS in the District.

Abstinence-reinforcing contingency management improves HIV viral load suppression among HIV-infected people who use drugs: A randomized controlled trial

BACKGROUND

HIV-infected people who use drugs (PWUD) have poor HIV outcomes. Few studies tested interventions to improve HIV outcomes among PWUD. Abstinence-reinforcing contingency management (CM) reduces drug use and could also improve HIV outcomes.

METHODS

From 2012-2017, we conducted a randomized controlled trial testing whether a 16-week abstinence-reinforcing CM intervention improved HIV viral load (VL) among HIV-infected adults using opioids or cocaine. In the CM intervention, drug-free urines led to escalating value of vouchers ($2.50-$80/voucher, $1320 total maximum). In intention-to-treat mixed-effects linear and logistic regression analyses, we examined whether the CM intervention improved log₁₀ VL (primary outcome), abstinence and antiretroviral adherence (secondary outcomes).

RESULTS

Thirty-seven participants were randomized to the CM intervention and 36 to control. Median age was 49.2 years; most were male (61.6%) and non-Hispanic black (46.6%). In CM (vs. control) participants, mean reduction in log₁₀ VL was greater (-0.16 log₁₀ VL copies/mL per 4-week period; 95% CI: -0.29 to -0.03, p < 0.05). Over 16 weeks, CM participants had a mean reduction of 0.64 copies/mL in log₁₀ VL greater than control participants. The CM intervention was not significantly associated with abstinence or adherence.

CONCLUSIONS

This is the first study to demonstrate improvements in HIV VL via an abstinence-reinforcing CM intervention. Because the CM intervention did not significantly affect abstinence or adherence, the mechanism of its effect is unclear. To end the HIV epidemic, innovative strategies must address individuals with poor HIV outcomes. Abstinence-reinforcing CM may be one potential strategy to improve HIV outcomes among a select group of PWUD.

Transmission Risk Among Youth Living With HIV in the U.S

PURPOSE

HIV treatment as prevention is effective for reducing the risk of HIV transmission and the messaging campaign, undetectable = untransmittable, is gaining recognition. As youth living with HIV (YLWH) who have condomless sex may acquire and potentially transmit other sexually transmitted infections (STIs), the purpose of this study was to assess potential differences in transmission risk of HIV and other STIs among YLWH to inform subsequent HIV and STI prevention efforts.

METHODS

A cohort of 600 HIV behaviorally infected youth aged 13-24 years who were engaged in medical care completed an audio computer-assisted self-interview including questions about demographics, HIV disclosure, mental health, substance use, and sexual behaviors and beliefs. HIV viral loads and the presence of other STIs were abstracted from medical records. A viral load <200 copies/mL was considered undetectable. Univariate and bivariate analyses were conducted to examine differences by viral load and STIs.

RESULTS

Participants were categorized into four groups: (1) undetectable without STIs (55.2%); (2) undetectable with STIs (14.2%); (3) detectable without STIs (22.8%); and (4) detectable with STIs (7.8%). In comparison to the other three groups, youth in the undetectable group with STIs reported more favorable sexual risk reduction attitudes and beliefs, internet use for finding sex partners, anal sex with male partners, and condomless anal sex with male partners.

CONCLUSIONS

YLWH with undetectable viral loads and other STIs engaged in higher risk behaviors. To realize the promise of the messaging campaign, undetectable = untransmittable, efforts must focus on sustained viral suppression and prevention of STIs among YLWH.

Multilevel Barriers to Engagement in the HIV Care Continuum Among Residents of the State of Rhode Island Living with HIV

An estimated 1.2 million people in the United States are living with HIV. Of those living with HIV, only 40% are engaged in HIV care, 37% are prescribed antiretroviral therapy (ART), and 30% are virally suppressed. Individual-, interpersonal-, and structural-level factors that represent barriers to engagement along the HIV care continuum are important to identify in order to inform priority areas and interventions. 296 adult residents of Rhode Island living with HIV between November 2015 and January 2016 were asked to participate in an observational study (Ryan White Part B Health Resources and Services Administration-funded consumer needs assessment) to identify the multilevel factors associated with engagement in the HIV care continuum outcomes (i.e., being retained in care, being prescribed ART, adhering to ART, and achieving viral suppression-all in the past 12 months). Multivariable logistic regression models were fit to model the four HIV care continuum outcomes. The majority of participants were over age 30 (92.5%), racial/ethnic minorities (67.1%), cisgender men (56.9%), and identified as straight/heterosexual (60.5%). Overall, 95.2% of participants were retained in care in the past 12 months, 93.0% were prescribed ART, 87.1% were currently adherent to ART, and 68.2% were virally suppressed. Factors positively associated with not being retained in HIV care in the past 12 months included having no income and challenges navigating the HIV care system. Being age 18-29 and having a provider who does not know how to treat people with HIV/AIDS were each positively associated with not being prescribed ART. Factors positively associated with not being adherent to ART included being age 18-29 and substance use in the past 12 months. Finally, having private insurance and having a provider who is not trustworthy were each positively associated with not being virally suppressed. Regardless of the fact that many of the individuals living with HIV in this sample are able to achieve an undetectable viral load, challenges with retention in HIV care and ART adherence threaten to undermine the clinical and public health benefits of treatment as prevention. Future longitudinal research conducted to better understand how to boost the effectiveness of treatment as prevention in this population should focus on examining the unique multilevel factors, polymorbidities, and conditions (mostly social determinants of health including housing, socioeconomic position, etc.) associated with suboptimal engagement across the stages of the HIV care continuum.

Effective public-private partnerships for sustainable antiretroviral therapy: outcomes of the Right to Care health services GP down-referral program

Background

The recently increased access to antiretroviral therapy (ART) in South Africa has placed additional strain on human and infrastructure resources of the public health sector. Capacity from private-sector General Practitioners (GPs) could be leveraged to ease the current burden on the public health sector.

Methods

We conducted a retrospective record review of routine electronic medical record data on a systematic sample of HIV-infected adults (≥18 years old) initiated on ART at a tertiary hospital outpatient HIV clinic in Johannesburg, South Africa and down-referred to private-GPs for continued care after stabilization on ART. We compared these patients (“GP down-referred”) to a control-cohort who remained at the referring site (“Clinic A”) and patients from a regional hospital outpatient HIV clinic not offering down-referral to GPs (“Clinic B”). Study outcomes assessed are viral load suppression (VL < 50 copies/ml) and attrition from care (all-cause-mortality or > 90-days late for a last-scheduled visit) by 12 months of follow-up following down-referral or eligibility.

Results

A total of 3685 patients, comprising 373 (10.1%) GP down-referred, 2599 (70.5%) clinic A controls, and 713 (19.4%) clinic B controls were included in the analysis. Overall, 1535 patients (53.3%) had a suppressed viral load. A higher portion of GP down-referred patients had a suppressed viral load compared to clinic A and B patients (65.7% vs 49.1% vs 58.9%). After adjusting for demographic and baseline clinical covariates, we found no difference in viral load suppression between GP down-referred and control patients (adjusted relative risk [aRR] for clinic A vs GP down-referred 1.0; 95% CI: 0.9–1.1), (aRR for clinic B vs GP down-referred 1.0; 95% CI: 0.9–1.2).

Clinic B controls experienced the highest attrition compared to GP down-referred and clinic A controls (33.2% vs 11.3% vs 5.9%) and had a higher risk of attrition compared to GP down-referred patients (adjusted hazard ratio [aHR] 4.2; 95% CI: 2.8–6.5), whereas clinic B controls had a lower risk of attrition (aHR 0.5; 95% CI: 0.3–0.7).

Conclusions and recommendations

Our results show that private-GPs can contribute to caring for stabilized public sector HIV patients on life-long ART. However, they require special efforts to improve retention in care.

Predictors of Time to Viral Load Suppression of Adult PLWHIV on ART in Arba Minch General Hospital: A Follow up Study

BACKGROUND

Access to antiretroviral drugs for all infected persons in need is a global health priority. The viral load and CD4 counts should be monitored regularly. The plasma viral load should be reduced by as much and for as short as possible. Identifying factors that predict time to viral load suppression of patients on antiretroviral therapy regimens is thus vital to optimizing therapeutic success. Therefore, this study aimed to estimate the time to viral load suppression and identify predictors of time to viral load suppression of patients on antiretroviral therapy at Arba Minch general Hospital.

METHODS

This study was observational study using data abstracted from medical records, patient interviews and laboratory work-up during 6 months of follow up. The data were collected from 152 naive to anti-retro viral drug patients. The univariable and multivariable Cox proportional hazard regression analyses were done to identify predictors.

RESULT

The median survival time of viral load suppression among adult patients living with HIV was 3 months with 95% CI (2.68, 3.32). The Cox-proportional hazard analysis shows baseline CD4 count of <200cells/mm3 (AHR=0.683, CI:0.471, 0.990), baseline viral load of <10,000 copies/ml (AHR=4.135, CI:1.835, 9.317), having baseline Cotrimoxazole preventive therapy (AHR=1.997, CI:1.108, 3.600), having baseline Isoniazid preventive therapy (AHR=3.085, CI:1.721, 5.529) and good adherence level to ART (AHR=2.648, CI: 1.202, 5.834) significantly predict the time to viral load suppression.

CONCLUSION

Early improvement and maintenance of CD4 count and viral load to normal level should be attained through streamlining and strengthening monitoring and counseling of patients on adherence to ART, Cotrimoxazole and Isoniazid drugs.

Effectiveness of a Viral Load Suppression Intervention for Highly Vulnerable People Living with HIV

We examine the effect of the Undetectables Intervention (UI) on viral loads among socially vulnerable HIV-positive clients. The UI utilized a toolkit that included financial incentives, graphic novels, and community-based case management services. A pre-post repeated measures analysis (n = 502) through 4 years examined longitudinal effects of the intervention. Logistic models regressed social determinants on viral loads. Finally, in-depth qualitative interviews (n = 30) examined how UI shaped adherence. The proportion of virally suppressed time-points increased 15% (from 67 to 82% pre to post-enrollment, p < 0.0001). The proportion of the sample virally suppressed at all time-points increased by 23% (from 39 to 62% pre to post-enrollment, p < 0.0001). African Americans and the homeless were the most likely to be unsuppressed at baseline, but, along with substance users, benefitted the most from UI. The intervention shaped adherence through two pathways, by: (1) establishing worth around adherence, and (2) increasing motivation to become suppressed, and maintain adherence.

Evaluating the effectiveness of the HIV adolescent package of care (APOC) training on viral load suppression in Kenya

OBJECTIVES

To evaluate the effectiveness of the implementation of the adolescent package of care (APOC) training on adolescent viral suppression at Family AIDS Care & Education Services (FACES)-supported sites.

STUDY DESIGN

The effect of APOC training was evaluated based on viral load suppression (<1000 copies/mL) of 10-19-year-olds in 13 FACES-supported sites in six months before (January 2015-August 2016) and after (November 2015-March 2017) the APOC training for each site.

METHODS

Patient-level data were abstracted from the FACES electronic medical records (OpenMRS) and the National AIDS and STI Control Programme viral load website. Information on adolescent clinic day implementation and utilization of an APOC checklist as a proxy for services provided at each site was collected. Generalized estimating equations with repeated measures clustered by patients were used for bivariate and multivariate modeling to assess factors associated with viral suppression.

RESULTS

In the pretraining period, 60% of adolescents received services at clinics offering adolescent clinic days compared to 95% in the post-training period. Among those tested, 65% were virally suppressed during the pretraining period compared to 72% during the post-training period (odds ratio [OR] = 1.31, 95% confidence interval [CI] 1.12, 1.53, P < 0.01). In multivariable analysis, there was no statistically significant change in viral load suppression due to APOC training (adjusted OR [aOR] = 0.97, 95% CI: 0.72, 1.30, P = 0.84). However, at clinics offering adolescent-friendly clinic days, adolescents were nearly 2 times more likely to be virally suppressed than at facilities not offering these specialized clinic days (aOR = 1.86, 95% CI: 1.04, 3.32, P = 0.04).

CONCLUSIONS

This study suggests that adolescent clinic days greatly improve adolescent viral load suppression and should be considered for implementation across HIV programs.

Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

Background

Human immunodeficiency virus (HIV) infected children represent a very vulnerable population for anti-retroviral therapy (ART) drug resistance. As a global target, 90% of patients receiving ART should have HIV-RNA viral suppression. A threshold of > 1000 RNA copies/ml is used to define non-suppressed viral load. If it is confirmed in the laboratory, adherence should be addressed and should be followed by the switch to second-line ART. Therefore, the aim of this study was to assess the rate of viral load suppression among children tested at the Amhara Public Health Institute (APHI), Bahir Dar.

Methods

Institutional based cross-sectional study design was conducted from July 01, 2017 to June 30, 2018, in children under the age of 15 years. Socio-demographic, clinical and HIV1RNA viral load data were collected from the excel database. The data were analyzed in SPSS 20.0 statistical software.

Results

A total of 1567 children, age ranged from one to 14 years, were tested for HIV viral load. Of which, about 54% were males. Children were treated using nevirapine-based (76.7%), efavirenz-based (21.8%) and protease inhibitor-based (1.5%) anti-retroviral drugs. Non-suppressed HIV viral load was found in 28.3% of the participants. High viral load (> 1000 cp/ml) were found in 24% of the children below the age of five years. Children on nevirapine-based treatment had about two times more non-suppressed viral load (Adjusted odds ratio [AOR]: 1.90; 95%CI: 1.41–2.56; P < 0.001) compared to those who had efavirenz-based treatment. However, adherence (P: 0.204) was not associated with non-suppressed viral load.

Conclusions

There was a high rate of non-suppressed HIV viral load among children tested at APHI. Specifically, the odds of having a non-suppressed viral load was higher in NVP based treatment users. Hence, comprehensive management and follow up of children on ART, and testing for resistance as well as viral load could help to reduce the problem in advance.

Associations between drug use patterns and viral load suppression among HIV-positive individuals who use support services in New York City

BACKGROUND

Drug use (DU) represents a significant barrier to maintaining physical health among people living with HIV (PLWH). Few studies, however, have examined the relationship between DU over time and HIV treatment outcomes. Such studies are needed because an individual's risk of poor health outcomes may vary with their DU behaviors. We examined associations between DU patterns over time and unsuppressed viral load (VL).

METHODS

The sample included 7896 PLWH in New York City who completed ≥3 substance use assessments over a 24-month period. DU was defined as crystal methamphetamine, crack/cocaine, heroin, and/or recreational prescription medication use in the last three months. Four behavior patterns were constructed: (1) persistent use (DU reported on each assessment); (2) intermittent use-active (DU reported on the third, but not all previous assessments); (3) intermittent use-inactive (DU reported previously with no DU reported on the third assessment); (4) persistent non-use (no DU reported on any assessment). Unsuppressed VL (>200 copies/mL) was assessed based on the last VL value in the New York City HIV Surveillance Registry in the 12 months following an individual's third DU assessment.

RESULTS

Compared with persistent non-users, individuals with intermittent use-inactive (aOR = 1.24, 95% CI = 1.03-1.49), intermittent use-active (aOR = 1.68, 95% CI = 1.36-2.06), and persistent use (aOR = 2.21, 95% CI = 1.69-2.89) were significantly more likely to have unsuppressed VL.

CONCLUSIONS

While providers may be more likely to intervene with persistent or active drug users, our findings suggest the importance of addressing the risk of poor HIV treatment outcomes among those with any DU behavior.

Baseline Neurocognitive Functioning Predicts Viral Load Suppression at 1-Year Follow-Up Among Newly Diagnosed HIV Infected Patients

The current prospective observational study evaluated the impact of baseline neurocognitive impairment on future viral load suppression among antiretroviral medication naive persons newly diagnosed with HIV infection. We used the Montreal Cognitive Assessment (MoCA) score less than 26, to identify patients with neurocognitive deficits. Of the 138 patients enrolled; virologic suppression was seen in 61% of the participants, while 72% of the participants had a MoCA score less than 26 at baseline. Variables significantly associated with low MoCA score included higher age (p < 0.01) and presence of depression (p < 0.01). After adjusting for these variables, MoCA score less than 26 was significantly associated with a higher risk of failing achieve viral load suppression (adjusted OR 2.7; 95% CI 1.09-6.69). Baseline neurocognitive deficit as measured by MoCA was associated with a higher risk for failing to achieve viral load suppression at one-year follow-up.

Virological failure among adolescents on ART, Harare City, 2017- a case-control study

BACKGROUND

Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10-19 years) on antiretroviral therapy (ART) in Harare city.

METHODS

We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI.

RESULTS

We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80-11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22-22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20-9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01-0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23-0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21-0.80)] were protective.

CONCLUSION

Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure.

Nationwide Estimates of Viral Load Suppression and Acquired HIV Drug Resistance in Cameroon

BACKGROUND

Population-based studies to estimate viral load (VL) suppression and rate of acquired HIV drug resistance (ADR) are essential in sub-Saharan Africa. We conducted the first nationally representative study estimating VL suppression and ADR in Cameroon.

METHODS

Eligible participants were patients on antiretroviral therapy (ART) for 12 to 24 months (ART 12-24) or 48 to 60 months (ART 48-60). ART 12-24 participants were recruited from 24 randomly selected clinics in both urban and rural regions. ART 48-60 participants were recruited from 7 urban clinics. Recruitment occurred from February to August 2015. Dried blood spots (DBSs) and plasma specimens were collected and tested for HIV-1 RNA level and presence of drug resistance mutations (DRM) when VL ≥ 1000 copies/ml.

RESULTS

Overall, 1064 ART 12-24 and 388 ART 48-60 participants were recruited. Viral suppression in the ART 12-24 group was 72.1% (95% CI: 66.3-77.2) overall, 75.0% (65.2-82.7) in urban sites, and 67.7% (58.3-75.8) in rural sites. In the ART 48-60 group, viral suppression was 67.7% (55.8-77.7). Overall, HIV drug resistance (HIVDR) was 17.7% (15.1-20.6) and 28.3% (17.4-42.5) in the ART 12-24 and ART 48-60 groups, respectively. However, among patients with VL ≥ 1000 copies/ml, HIVDR was identified in 63.3% (52.0-73.3) of ART 12-24 patients, and in 87.7% (67.4-96.1) of ART 48-60 patients.

CONCLUSIONS

Results of this first nationwide study indicate alarming levels of virological failure and ADR in Cameroon. Better ART management is urgently needed and should focus on improving ART adherence, availability of VL monitoring, and more timely switches to second-line ART.

Caregivers' Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients

Informal care receipt is associated with health outcomes among people living with HIV. Less is known about how caregivers' own social support may affect their care recipient's health. We examined associations between network characteristics of informal caregivers and HIV viral suppression among former or current drug using care recipients. We analyzed data from 258 caregiver-recipient dyads from the Beacon study, of whom 89% of caregivers were African American and 59% were female. In adjusted logistic regression analysis, care recipients had lower odds of being virally suppressed if their caregiver was female, was caring for youth involved in the criminal justice system, and had network members who used illicit drugs. Caregivers' greater numbers of non-kin in their support network was positively associated with viral suppression among care recipients. The findings reveal contextual factors affecting ART outcomes and the need for interventions to support caregivers, especially HIV caregiving women with high-risk youth.

Retention, Antiretroviral Therapy Use and Viral Suppression by History of Injection Drug Use Among HIV-Infected Patients in an Urban HIV Clinical Cohort

Compared to HIV-infected persons who do not inject drugs (non-IDU), persons who inject drugs (PWID) experience disparities in linking to medical care, initiating antiretroviral therapy (ART) and achieving viral suppression. There has been little attention to changes in these disparities over time. We estimated the proportion of PWID and non-IDU retained in care, on ART, and virally suppressed each year from 2001-2012 in the Johns Hopkins HIV Clinical Cohort (JHHCC). We defined active clinic patients as those who had ≥1 clinical visit, CD4 cell count, or viral load between July 1 of the prior year, and June 30 of the analysis year. Within a calendar year, retention was defined as ≥2 clinical visits or HIV-related laboratory measurements >90 days; ART use was defined as ≥1 ART prescription active ≥30 days; and viral suppression was defined as ≥1 HIV viral load <400 copies/mL. While PWID were less likely to be retained in earlier years, the gaps in retention closed around 2010. After 2003-2004, PWID and non-IDU retained in care had similar probability of receiving a prescription for ART and PWID and non-IDU on ART had similar probability of viral suppression.