Virological Non-Suppression, Non-Adherence and the Associated Factors Among People Living with HIV on Dolutegravir-Based Regimens: A Retrospective Cohort Study

Abstract

Background

HIV is one of the leading causes of morbidity and mortality, with 39.0 million people living with HIV worldwide, 25.6 million of whom reside in the African region. Highly active anti-retroviral therapy (HAART) has improved survival and quality of life, yet some patients develop viral non-suppression. Dolutegravir (DTG) has been recommended since 2018 as a first-line treatment option in low- and middle-income countries owing to its effectiveness, low cost, and tolerability, but some studies have reported virological non-suppression with its use. This study aims to explore the prevalence and factors associated with virological non-suppression in adults taking DTG-based regimens in Mbarara Regional Referral Hospital.

Methods

A retrospective cohort study was carried out among people living with HIV (PLWHIV) taking DTG-based HAART regimens by way of record review. SPSS was used for analysis, and both binary and multivariate logistic regression analyses were performed to test associated factors.

Results

Among the 422 participants’ records reviewed, 62.8% were female (median age 40 years, IQR=13). The prevalence of virological non-suppression was 4.2%. Poor adherence to HAART was significantly associated with virological non-suppression, with 100.3 increased adjusted odds (95% CI: 28.90–348.12, p<0.001) compared to those with a record of good adherence. The reasons for poor adherence included alcohol use, stigma, forgetting to take medication, transport problems, and irregular timing of swallowing.

Conclusion

This study found poor adherence to be associated with a 4.2% prevalence of virological non-suppression among PLWHIV in a large public HIV care clinic. Despite the high suppression rates on DTG-based regimens, adherence counseling and viral load monitoring need to be emphasized at all HIV care centers to mark the trends of virological non-suppression.

Keywords:

• virological
• non-suppression
• dolutegravir
• regimens

Abbreviations

AE, adverse event; ART, anti-retroviral therapy; DTG, dolutegravir; EFV, efavirenz; FDA, Food and Drug Administration; HAART, highly active anti-retroviral therapy; HIV, human immunodeficiency virus; ISS, immune suppression syndrome; MRRH, Mbarara Regional Referral Hospital; MUST, Mbarara University of Science and Technology; PI, principal investigator; PLHIV, people living with HIV; UNAIDS, Joint United Nations Programme on HIV/AIDS; WHO, World Health Organization.

Data Sharing Statement

The data set and data collection tools used in this study are available upon reasonable request from the corresponding author.

Ethical Approval

This study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Research and Ethics Committee (REC) of Mbarara University of Science and Technology (MUST); a waiver of informed consent was requested from REC.

Confidentiality was ensured by making sure that patients’ names and any information that could identify them were not included in the data collection tool or were removed from the extracted data. The PI, health professionals on duty, research assistants, patients, and caregivers were protected from any harm, embarrassment, or exposure, especially to COVID-19, through adherence to the standard operating procedures, including social distancing, and the use of face masks, sanitizer, and hand washing. The clinical routines were not interrupted by the study.

Acknowledgments

We would like to thank the staff of Mbarara Regional Referral Hospital who collaborated with us during data collection. We would also like to extend our thanks to the research assistants for their unreserved support.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no competing interests in the research, authorship, and publication of this article.

Additional information

Funding

There is no funding to report.