Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland

PLoS One. 2015 Feb 19;10(2):e0116144. doi: 10.1371/journal.pone.0116144. eCollection 2015.

Abstract

Introduction: This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland.

Methods: This descriptive study used laboratory data from 7/5/2012 to 30/9/2013, which were linked with the national ART database to provide information on time on ART and CD4 count; information on enhanced adherence counselling was obtained from file review in health facilities. Multivariable logistic regression was used to explore the relationship between viral load, gender, age, time on ART, CD4 count and receiving (or not receiving) enhanced adherence counselling.

Results: From 12,063 patients undergoing routine viral load monitoring, 1941 (16%) had detectable viral loads. Children were more likely to have detectable viral loads (AOR 2.6, 95%CI 1.5-4.5), as were adolescents (AOR 3.2, 95%CI 2.2-4.8), patients with last CD4<350 cells/µl (AOR 2.2, 95%CI 1.7-2.9) or WHO Stage 3/4 disease (AOR 1.3, 95%CI 1.1-1.6), and patients on ART for longer (AOR 1.1, 95%CI 1.1-1.2). At retesting, 450 (54% of those tested) showed viral re-suppression. Children were less likely to re-suppress (AOR 0.2, 95%CI 0.1-0.7), as were adolescents (AOR 0.3, 95%CI 0.2-0.8), those with initial viral load> 1000 copies/ml (AOR 0.3, 95%CI 0.1-0.7), and those with last CD4<350 cells/µl (AOR 0.4, 95%CI 0.2-0.7). Receiving (or not receiving) enhanced adherence counselling was not associated with likelihood of re-suppression.

Conclusions: Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Child
  • Counseling*
  • Eswatini
  • Female
  • HIV Infections / drug therapy*
  • Humans
  • Logistic Models
  • Male
  • Viral Load
  • Young Adult

Substances

  • Anti-HIV Agents

Grants and funding

The author(s) received no specific funding for this work. This research was supported through an operational research course, which was jointly developed and run by the Operational Research Unit (LUXOR), Médecins Sans Frontières, Brussels Operational Centre, Luxembourg; the Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France and The Union South-East Asia Regional Office, Delhi, India. Additional support for running the course was provided by the Institute for Tropical Medicine, Antwerp, Belgium; the Center for International Health, University of Bergen; the University of Nairobi, Kenya and Partners In Health, Rwanda. This course is under the umbrella of the World Health Organization (WHO-TDR) SORT-IT programme (Structured Operational Research and Training Initiative) for capacity building in low- and middle-income countries. Funding for the course was provided by Médecins Sans Frontières Luxembourg, Brussels Operational Centre, Luxembourg, the Bloomberg Philanthropies and the Department for International Development (DFID), UK. The funders of the course had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.