Failure to Attain HIV Viral Suppression After Intensified Adherence Counselling—What Can We Learn About Its Factors?

Figures & data

Table 1 Participants’ Demographic and Clinical Characteristics (N = 212)

Variable	Number/Mean	Proportion (%) /SD
Sex
Female	134	63.2
Male	78	36.8
Mean age ± SD	43.2	11.8
Age Group in years
18–25	22	10.3
26–35	23	10.9
36–45	80	37.7
46–55	58	27.4
56–70	29	13.7
Marital Status
Divorced	31	14.6
Married	81	38.2
Separated	8	3.8
Single	54	25.5
Widowed	38	17.9
BMI
Underweight	106	50.0
Normal weight	87	41.0
Overweight	14	6.6
Obese	5	2.4
WHO-Staging
Stage 1	32	15.1
Stage 2	52	24.5
Stage 3	92	43.4
Stage 4	36	17.0
CTCs
Bugando Medical Centre	112	52.8
Sekou-Toure Regional Referral Hospital	100	47.2
These are the Districts Represented
Nyamagana	111	52.4
Ilemela	78	36.8
Other Districts	23	10.8

Abbreviations: SD, Standard deviation; CTCs, Care and Treatment Clinics.

Table 2 ARTs Adherence and Virological Status Before and After IAC (N = 212)

Variable		Before IAC		After IAC		Chi-Square	P-value
		Number (n)	Proportion (%)	Number (n)	Proportion (%)
ARTs Adherence	Good (≥95%)	141	66.5	182	85.9
	Poor (<95%)	71	33.5	30	14.1	29.25	0.001
Median (M) Viral Load		M(IQR)		M(IQR)
		12,473.5 (3935.5–57,267.5)		0 (0–645.5)		-	0.001

Abbreviations: IAC, Intensified adherence counselling; IQR, Interquartile range.

Table 3 Prevalence of Virological Suppression After IAC (N = 212)

Variable		Viral Load After IAC	Proportion (%)
		Number (n)
Virological Status	TND (<50 copies/mL)	131	61.8
	Suppressed Viral load (50<1000 copies/mL)	29	13.7
	Unsuppressed (Viral load ≥1000 copies/ mL)	52	24.5

Abbreviations: IAC, Intensified adherence counselling; TND, Test not detected.

Table 4 Factors Associated with Adherence Before and After Intensified Adherence Counselling (N = 212)

Variable	Participants Achieved Adherence
	Before Intensified Adherence Counselling				After Intensified Adherence Counselling
	Univariate	p-value	Multivariate	p-value	Univariate	p-value	Multivariate	p-value
	OR [95% CI]		OR [95 CI]		OR [95% CI]		OR [95 CI]
Gender
Male	0.6 (0.3 1.1)	0.077			0.5 (0.2 1.2)	0.109	0.7 (0.3 1.3)	0.234
Female	1.0				1.0		1.0
Marital status
Divorced	2.5 (0.9 6.8)	0.067	2.7 (1.0 7.6)	0.055	10.6 (1.4 82.5)	0.024	2.2 (0.7 6.5)	0.160
Married	2.2 (0.7 7.0)	0.19	2.4 (0.7 8.2)	0.147	7.1 (0.8 64.5)	0.081	2.3 (0.7 7.7)	0.187
Separated	1.8 (0.3 11.0)	0.536	2.4 (0.4 16.0)	0.361	-	-	2.3 (0.3 15.6)	0.385
Single	5.7 (2.1 16.0)	0.001	7.9 (2.5 25.0)	0.001	4.6 (0.5 40.1)	0.165	6.8 (2.1 22.2)	0.001
Widow	1.0		1.0		1.0	1.0
Age Groups
18–25	1.0 (0.4 2.7)	0.97	0.3 (0.1 1.1)	0.071	0.2 (0.0 1.7)	0.139	0.3 (0.1 1.0)	0.051
26–35	0.8 (0.3 2.1)	0.584	0.7 (0.2 1.9)	0.437	0.9 (0.3 3.2)	0.869	0.7 (0.2 2.2)	0.567
36–45	0.6 (0.3 1.2)	0.124	0.6 (0.3 1.2)	0.13	0.6 (0.2 1.6)	0.300	0.6 (0.3 1.2)	0.146
46–55	1.0		1.0		1.0
56–70	0.5 (0.2 1.2)	0.118	0.5 (0.2 1.5)	0.231	0.7 (0.2 2.4)	0.549	0.5 (0.2 1.5)	0.207
ART Duration
<11 Years	1.0				1.0		1.0
≥11 Years	1.5 (0.8 2.7)	0.16	1.4 (0.8 2.7)	0.221	2.7 (1.2 6.3)	0.019	1.5 (0.8 2.7)	0.231
Disclosure
Yes	1.5 (0.4 4.7)	0.539	-	-	1.2 (0.3 5.9)	0.797	-	-
No	1.0				1.0
Unsafe sex
Yes	1.1 (0.5 2.3)	0.816	-	-	1.5 (0.6 3.9)	0.363	-	-
No	1.0				1.0
Use of Local Medicine
Yes	0.3 (0.1 1.4)	0.134	0.3 (0.0 1.4)	0.119	2.6 (0.8 9.1)	0.121	0.3 (0.1 1.4)	0.112
No	1.0				1.0		1.0
Residency
Nyamagana	1.2 (0.8 1.9)	0.338	-	-	1.5 (0.9 2.7)	0.117	1.1 (0.7 1.7)	0.793
Ilemela	1.0				1.0		1.0

Table 5 Factors Associated with Virological Failure After Intensified Adherence Counselling (N = 212)

Variables	Viral Load Suppression		Univariate		Multivariate
	Success	Failure	OR [95% CI]	p-value	OR [95 CI]	p-value
	n (%)	n (%)
Gender
Male	55 (70.5)	23 (29.5)	1.0
Female	105 (78.4)	29 (21.6)	0.7 (0.4–1.3)	0.202	0.8 (0.3–2.1)	0.684
Marital Status
Divorced	25 (80.7)	6 (19.4)	0.8 (0.3–2.5)		0.8 (1.1–3.1)	0.792
Married	67 (82.7)	14 (17.3)	1.0
Separated	7 (87.5)	1 (12.5)	0.7 (0.9–6.0)	0.732	0.7 (0.1–8.7)	0.766
Single	31 (57.4)	23 (42.6)	3.6 (1.6–7.8)	<0.002	2.2 (0.5–9.4)	0.277
Widow	30 (79.0)	8 (21.0)	1.3 (0.48–3.36)	0.622	2.6 (0.57–11.72)	0.221
Age group, in years
18–25	9 (40.9)	13 (59.1)	7.9 (2.6–23.8)	<0.001	6.0 (1.1–29.6)	<0.043
26–35	16 (69.6)	7 (30.4)	2.4 (0.8–7.4)	0.135	2.1 (0.5–8.7)	0.312
36–45	60 (75.0)	20 (25.0)	1.8 (0.8 4.3)	0.181	1.7 (0.6–4.7)	0.338
46–55	49 (84.5)	9 15 (52)	1.0
56–70	26 (89.7)	3 (10.34)	0.6 (0.2–2.5)	0.512	0.37 (0.1–1.7)	0.201
Disclosure
Yes	154 (77.0)	46 (23.0)	1.0
No	6 (50.0)	6 (50.0)	3.3 (1.1–10.9)	<0.044	1.4 (0.3–7.1)	0.609
Unsafe Sex
Yes	31 (83.8)	6 (16.2)	0.5 (0.2–1.4)	0.202	0.4 (0.1–1.2)	0.107
No	129 (73.7)	46 (26.3)	1.0
Use of alcohol
Yes	9 (90.0)	1 (10.0)	0.3 (0.1–2.7)	0.297	0.2 (0.1–2.5)	0.229
No	151 (74.8)	51 (25.2)	1.0
Adherence after IAC
Good adherence	140 (87.5)	20 (12. 5)	1.0
Poor Adherence	42 (80.8)	10 (19.2)	1.7 (0.7–3.8)	0.230	4.1 (1.3–12.5)	0.014
WHO-Clinical Stage
Stage 1	21 (13.1)	11 (21.2)	1.0
Stage 2	42 (26.3)	10 (19.2)	0.5 (0.1–1.2)	0.124	0.3 (0.1–1.1)	0.053
Stage 3	69 (43.1)	23 (44.2)	0.6 (0.3–1.5)	0.308	0.6 (0.2–1.7)	0.304
Stage 4	28 (17.5)	8 (15.4)	0.5 (0.2–1.6)	0.732	0.4 (0.1–1.4)	0.150
Client Categories Upon starting ART
Stable	60 (37.5)	31 (59.6)	1.0
Unstable	100 (62.5)	21 (40.4)	2.5 (2.3–4.7)	<0.006	0.2 (0.1–0.6)	0.002
ART Duration
<11 Years	81 (50.6)	24 (46.2)	1.0
	79 (49.4)	28 (53.9)	0.8 (0.4–1.6)	0.576	-

Notes: Disclosure of HIV status to sexual partner and none sexual partner. Unsafe sex participating in a sexual partnership without condom for the past 30 days. Use of alcohol use of 5 bottle of alcoholic drink or more in past 30 days. Stable client are clients who are on ART for at least six months and have no adverse drug reactions that require regular monitoring, no current illness have good understanding of lifelong adherence of 95% and kept clinic visit appointment for the past six months with undetectable viral load of less than 50 copies/ mL. Unstable client are clients who are on ART for at least six months and have an active opportunistic infection (including TB) or uncontrolled co-morbidities in the past six-month, Poor or questionable adherence to scheduled clinic visits in the past six months.