Factors associated with Virological non-suppression among adult PLHIV after receiving Intensive Adherence Counseling at Taso Mbale, Eastern Uganda: A Cross-sectional Study

Background: According to the Joint United Nations Program (JUNP) on HIV/AIDS through the ambitious 95-95-95 target, 95% of people living with HIV (PLHIV) on antiretroviral treatment (ART) should be virally suppressed. Viral load (VL) non-suppression has been found to be associated with ART adherence, and intensive adherence counseling (IAC) has been shown to lead to VL re-suppression by over 70% in PLHIV on ART. Although Uganda has employed the IAC intervention program since 2015, there is paucity of research data on HIV viral load non-suppression after IAC. Methodology: This was a Cross-sectional study, conducted in TASO Mbale. Data were abstracted for all clients with non-suppressed viral load between Jan 2018 to August 2021 from the TASO Mbale program database and various parameters were considered. These parameters included the IACs done, the repeat VL done, presence of an opportunistic infection, sex, age, and the current regimen. A client was considered to have a non-virological status if there were >1000 copies of CD4 cells. The clients were followed for a maximum period of 43 months. A total of 13428 person months was observed for different periods. The data were then analyzed using statistical software Stata version 14. Bivariate analysis was done for all covariates. Hazard ratios (HRs) were estimated as a degree of association between viral non-suppression and client features, via a Cox proportional hazards regression. Results: A total of 442 PLHIV after IAC were enrolled, of whom 60 (13.6%) had VL non suppression following IAC. The overall rate of VL non-suppression was 4.47 (3.41-5.75) per 1000 person-months (PM) of observation after IAC. ART regimen was statistically significant with viral load suppression especially DTG-3TC-LPV/r based regimen had (AHR=5.78, 95%CI, 1.137-29.384, p=0.034). Poor adherence level to ART had significant contribution to viral load non-suppression (AHR=4.88, 95%CI: 1. 607-14.836, p=0.005). Conclusion: Virological non-suppression after IAC was found at 13.6% and associated with patients’ poor adherence level. Viral load suppression was associated with DTG-3TC-LPV/r and AZT-3TC-LPV/r based regimens. The findings lend a huge boost towards the third UNAIDS target of 95%.