Impact of Enhanced Adherence Counselling on PLHIV with Unsuppressed Viral Load and Prevalence of Virological Failure in Osogbo, Nigeria: A Quasi-experimental Study

Background Enhanced adherence counselling (EAC) is an important strategic intervention to prevent virological failure among people living with HIV (PLHIV) with unsuppressed viral loads. However, inconsistencies exist as regards EAC efficacy. Therefore, this study set out to determine the impact of EAC on PLHIV with unsuppressed viral loads, and the prevalence of virological failure in Osogbo, Nigeria. Methods One hundred twenty-nine PLHIV with unsuppressed viral load ≥ 1000 copies per millilitre from three hospitals had three sessions of EAC on monthly basis. The barriers to optimal adherence to antiretroviral therapy were identified and strategic actions were deployed. After EAC sessions, participants’ HIV viral loads were assayed. EAC impact was determined by the percentage of participants with suppressed viral load < 1000 copies per millilitre, and comparison of the participants’ mean viral load before and after EAC. Results One hundred four (80.6%) participants had viral suppression after EAC while 25 (19.4%) still had unsuppressed viral load (virological failure). The impact of EAC in this study was 80.6% (104/129) favourable outcome and significantly lower mean viral load after EAC (p = 0.001). The major barriers identified were forgetfulness, far distance to the treatment centre and stigma, and the most impactful strategic actions instituted were peer support and extended drug pick-up. Conclusion EAC is impactful with over 80% success rate and significantly lower mean viral load of the participants. Peer support and extended drug pick-up were most impactful strategic actions. It is therefore recommended that all stakeholders in HIV/AIDS care should be wholly committed EAC.