Social and behavioral factors associated with failing second-line ART – results from a cohort study at the Themba Lethu Clinic, Johannesburg, South Africa

ABSTRACT

Poor adherence is a main challenge to successful second-line ART in South Africa. Studies have shown that patients can re-suppress their viral load following intensive adherence counselling. We identify factors associated with failure to re-suppress on second-line ART.

The study was a retrospective cohort study which included HIV-positive adults who experienced an elevated viral load ≥400 copies/ml on second-line ART between January 2013–July 2014, had completed an adherence counselling questionnaire and had a repeat viral load result recorded within 6 months of intensive adherence counselling. Log-binomial regression was used to evaluate the association between patient characteristics and social, behavioral or occupational factors and failure to suppress viral load (≥400 copies/ml).

A total of 128 patients were included in the analysis, and of these 39% (n = 50) failed to re-suppress their viral load. Compared to those who suppressed, far more patients who failed to suppress reported living with family (44.2% vs. 23.7%), missing a dose in the past week (53.3% vs. 30.0%), using traditional/herbal medications (63.2% vs. 34.3%) or had symptoms suggestive of depression (57.7% vs. 34.3%).

These patient-related factors could be targeted for interventions to reduce the risk for treatment failure and prevent switching to expensive third-line ART.

KEYWORDS:

• second-line antiretroviral therapy
• resource limited setting
• virologic failure
• viral suppression
• intensive adherence counselling

Acknowledgements

We acknowledge the directors and staff of Themba Lethu Clinic (TLC), Clinical HIV Research Unit (CHRU), HE²RO and Right to Care (RTC) – a PEPFAR (US President’s Emergency Plan for AIDS Relief) funded NGO, the Gauteng Provincial and National Department of Health for providing for the care of the patients at Themba Lethu Clinic as part of the National Comprehensive Care, Management and Treatment (CCMT) of HIV and AIDS program. Lastly, we would like to sincerely thank the patients attending the Themba Lethu Clinic for their continued trust in the treatment and care provided at the clinic.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

This study is made possible by the generous support of the American people through Cooperative Agreement AID 674-A-12-00029 from the United States Agency for International Development (USAID). The contents of the aricle are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government. The funders had no role in the study design, collection, analysis and interpretation of the data, in manuscript preparation of the decision to publish.

Authors’ contributions

DE, RB and EL were involved in conception and design. IJ and RB were involved in study implementation while DE and SD undertook data collection and management. SD, CG, and TS were involved in data collection and review of patient files. EL and DE were the supervisor and co-supervisor of SD’s Master’s in Medicine research project. MPF, DE, RB, SD were involved in data analysis and interpretation of data. IJ and RB were involved clinical interpretation and contributed to the Discussion and Limitations sections. SD drafted the first manuscript and all authors were involved in revising it critically for important intellectual content and final approval of the manuscript.

ORCID

Denise Evans http://orcid.org/0000-0003-0698-1228

Additional information

Funding

MPF, DE, TS, CG and RB were supported through the South Africa Mission of the United States Agency for International Development (USAID) under the terms of Cooperative Agreement USAID-674-A-12-00029 to the Health Economics and Epidemiology Research Office. SD received a scholarship from Swedish International Development Cooperation Agency (SIDA; http://www.sida.org).