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

Figures & data

Table 1 Sociodemographic Characteristics of People Living with HIV at Mbarara Regional Referral Hospital

Variable		Frequency	Percentage
Sex	Female	265	62.8
	Male	157	37.2
Age (years)	≤35	123	29.1
	36–45	168	39.8
	>45	131	31.0
Family planning used	Hormonal	104	25.2
	Non-hormonal	276	67.0
	None	32	7.8
Education status	Primary	49	14.6
	Secondary	184	54.9
	Tertiary	102	30.4
Occupation	Unemployed	67	17.4
	Employed	21	5.5
	Business	90	23.4
	Peasant	206	53.6
Marital status	Separated	115	27.8
	Single	54	13.0
	Married	245	59.2
Religion	Catholic	119	33.6
	Protestant	195	55.1
	Others	40	11.3
Alcohol use	No	323	76.5
	Yes	99	23.5

Table 2 Clinical Characteristics of People Living with HIV at Mbarara Regional Referral Hospital

Variable		Frequency	Percentage
Discordance	No	364	86.3
	Yes	22	5.2
	Unknown	36	8.5
Disclosure status	No	29	9.4
	Yes	281	90.6
Drug allergy	No	419	99.3
	Yes	3	0.7
Prior ART use	PMTCT	1	50.0
	PEP	1	50.0
Ever changed regimen	No	313	74.2
	Yes	109	25.8
Current regimen	ABC/3TC/DTG	2	0.47
	TDF/3TC/DTG	415	98.3
	TDF/3TC/DTG/DRV/r	2	0.47
	AZT/3TC/DTG	3	0.71
Regimen before DTG substitution	None	29	6.9
	TDF/3TC/EFV	265	62.8
	TDF/3TC/NVP	13	3.1
	AZT/3TC/NVP	67	15.9
	AZT/3TC/EFV	37	8.8
	Others [TDF/3TC/ATV/r, CBV/LPV/r, TDF/3TC LPV/r, ABC/3TC/EFV]	11	2.3
Duration on HAART (years)	≤5	59	14.0
	6–10	187	44.3
	>10	176	41.7
Duration on DTG-based regimen (years)	≤2	185	43.8
	>2	237	56.2
HAART line of treatment	1	412	97.6
	2	9	2.1
	3	1	0.2
Ever taken INH	No	0	0.0
	Yes	422	100.0
Opportunistic infections	None	419	99.3
	Genital ulcer disease	1	0.7
	Oral thrush	1
	TB	1
Comorbidity	No	412	97.6
	Yes	10	2.4
Current HAART adherence	Good	390	95.8
	Fair	2	0.5
	Poor	15	3.7
DTG-baseline adherence	Good	376	99.5
	Fair	1	0.3
	Poor	1	0.3

Abbreviations: ABC, abacavir; ART, anti-retroviral therapy; ATV/r, atazanavir/ritonavir; AZT, azidothymidine; CBV, carbovir; DRV, darunavir; DTG, dolutegravir; DTG/r, dolutegravir/ritonavir; EFV, efavirenz; HAART, highly active anti-retroviral therapy; INH, isoniazid; LPV, lopinavir; LPV/r, lopinavir/ritonavir; NVP, nevirapine; PEP, post-exposure prophylaxis; PMTCT, prevention of mother-to-child transmission; TB, tuberculosis; 3TC, lamivudine; TDF, tenofovir.

Figure 1 Prevalence of virological non-suppression among people living with HIV on dolutegravir-based highly active anti-retroviral therapy regimens.

Figure 2 Time taken for non-suppression of viral load from the start of the DTG-based regimen.

Abbreviations: DTG, dolutegravir; HAART, highly active anti-retroviral therapy.

Figure 3 Bar chart showing reasons for poor adherence among people living with HIV using dolutegravir-based regimens at Mbarara Regional Referral Hospital.

Table 3 Univariate and Multivariate Logistic Regression of the Factors Associated with Virological Non-Suppression Among People Living with HIV on DTG-Based Regimens at Mbarara Regional Referral Hospital

Variable	Category	Virological Non-Suppression, n (%)		COR (95% CI)	p Value	AOR (95% CI)	p Value
		No	Yes
Gender	Female	254 (95.8)	11 (4.2)	0.93 (0.35–2.45)	0.880
	Male	15 (95.5)	7 (4.5)	1
Age category (years)	≤35	120 (97.6)	3 (2.4)	0.63 (0.15–2.69)	0.533
	36–45	158 (94.0)	10 (6.0)	1.60 (0.53–4.79)	0.405
	>45	126 (96.2)	5 (3.8)	1
Education level	Primary	49 (100)	0	–	0.997
	Secondary	176 (95.7)	8 (4.3)	1.11 (0.33–3.79)	0.863
	Tertiary	98 (96.1)	4 (3.9)	1
Marital status	Separated	111 (96.5)	4 (3.5)	0.85 (0.26–2.76)	0.783
	Single	52 (96.3)	2 (3.7)	0.90 (0.19–4.25)	0.898
	Married	235 (95.9)	10 (4.1)	1
Discordance	No	348 (95.6)	16 (4.4)	1
	Yes	21 (95.5)	1 (4.5)	1.04 (0.131–8.19)	0.973
	Unknown	35 (97.2)	1 (2.8)	0.62 (0.08–4.83)	0.649
Occupation	Unemployed	65 (97.0)	2 (3.0)	0.55 (0.118–2.525)	0.438
	Employed	20 (95.2)	1 (4.8)	0.89 (0.109–7.225)	0.910
	Business	87 (96.7)	3 (3.3)	0.61 (0.166–0.246)	0.459
	Peasant	195 (94.7)	11 (5.3)	1
Disclosure status	No	29 (100)	0	–	–
	Yes	269 (95.7)	12 (4.3)	1
Alcohol use	No	313 (96.9)	10 (3.1)	1		1
	Yes	91 (91.9)	8 (8.1)	2.75 (1.06–7.18)	0.038	2.05 (0.57–7.32)	0.271
Ever changed regimen	No	297 (94.9)	16 (5.1)	2.88 (0.65–12.74)	0.163	3.04 (0.51–18.21)	0.224
	Yes	107 (98.2)	2 (1.8)	1		1
Duration on DTG (years)	≤2	181 (97.8)	4 (2.2)	1		1
	>2	223 (94.1)	14 (5.9)	2.84 (0.92–8.78)	0.070	2.60 (0.66–10.32)	0.174
Duration on HAART (years)	≤10	237 (96.3)	9 (3.7)	0.71 (0.27–1.81)	0.468
	>10	167 (94.9)	9 (5.1)	1
Adherence	Good	383 (98.2)	7 (1.8)	1		1
	Poor	6 (35.3)	11 (64.7)	100.31 (28.90–348.12)	<0.001	100.30 (28.90–348.12)	<0.001
Family planning	Hormonal	99 (95.2)	5 (4.8)	1.11 (0.38–3.24)	0.847
	Non-hormonal	264 (95.7)	12 (4.3)	1
Baseline CD4 count	<500	199 (95.7)	9 (4.3)	0.85 (0.33–2.19)	0.735
	≥500	169 (94.9)	9 (5.1)	1
Stage at start of DTG	I	347 (95.3)	17 (4.7)	2.79 (0.37–21.39)	0.323
	II–IV	57 (98.3)	1 (1.7)	1
Number of regimens ever changed	1	75 (96.2)	3 (3.8)	1.56 (0.25–9.80)	0.634
	2–5	32 (94.1)	2 (5.9)	1
Baseline regimen	Others	48 (98.0)	1 (2.0)	1
	TDF/3TC/EFV	188 (95.4)	9 (4.6)	2.30 (0.28–18.58)	0.435
	AZT/3TC/EFV or [NVP]	140 (95.2)	7 (4.8)	2.40 (0.29–20.01)	0.418

Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; COR, crude odds ratio; DTG, dolutegravir; EFV, efavirenz; NVP, nevirapine; 3TC, lamivudine; TDF, tenofovir.

Data Sharing Statement

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