The Viral Load Suppression in Participants Excluded From the NAMSAL Trial: A Retrospective Cohort Study

Background For years now, research on HIV treatment has been yielding better therapeutic options. This is the case of the NAMSAL (New Anti-retroviral and Monitoring Strategies in Adults living with HIV in Low-income countries) study that took place in Yaoundé, Cameroon. Throughout the study, participants were excluded for various reasons, which could affect treatment outcomes. For the best of our knowledge, there is little data on viral suppression in people excluded from trials. Our aim was to assess these participants’ viral suppression rates and associated factors. Methods We conducted a hospital-based retrospective cohort study in the three hospitals in Yaoundé where the NAMSAL study took place: Yaoundé Central Hospital (YCH), Yaoundé Military Hospital (YMH) and Cité-Verte District Hospital (CVDH). Data were collected from 2018 to 2021. Viral Suppression (VS) was defined as viral load (VL) < 1000 copies/mL. Associated factors were analyzed using Chi-square tests and logistic regression. Analyses were performed using R software, with a p-value < 0.05 significant. Results The study population (n = 132) had a median age of 34 years (range: 23–51), with 51.5% males and 48.5% females. Most participants were single (72.7%) and employed (63.6%). The majority (57.6%) had baseline VL below 100,000 copies/mL. VS rates were 77.3%, 72.6% and 61.5% at weeks 48, 96, and 144, respectively. Factors associated with viral suppression after weeks 48 and 96 included low initial VL (OR: 0.029 [95% CI: 0.003–0.301], p  = 0.003), unemployment (OR: 0.112 [95% CI: 0.022–0.559], p  = 0.008) and on first-line ART (OR: 0.093 [95% CI: 0.019–0.453], p  = 0.003). Conclusion Participants excluded from the NAMSAL study achieved an acceptable viral suppression rate after two years, with low initial viral load, unemployment, and first-line ART treatment as significant factors. This highlighted the importance of early diagnosis, specialized counselling to male patients and increased observance on adherence.