FACTORS ASSOCIATED WITH VIRAL NON-SUPPRESSION AMONG HIV-POSITIVE PATIENTS ON ANTIRETROVIRAL THERAPY IN SIERRA LEONE, JANUARY 2018–JUNE 2019

Abstract

Despite the growing number of people on antiretroviral therapy (ART), there is limited information about viral non-suppression and its determinants among HIV-positive individuals enrolled in HIV care in many resource-limited settings. We estimated the proportion of virally non-suppressed patients, and identified the factors associated with viral non-suppression. We conducted a descriptive cross-sectional study using routinely collected program data from viral load (VL) samples collected across the country for testing at the Central Public Health Reference Laboratories (CPHRL) in Sierra Leone. Data were generated between January 2018 and December 2019. We extracted data on socio-demographic, clinical and VL testing results. We defined viral non-suppression as having ≥1000 copies of viral RNA/ml of blood for plasma or ≥5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with viral non-suppression. This study consisted of 8,657 patients, of whom 4224 (74%) were male, and 94.3% were older than 15 years old. Of the total, 7619 (88%) patients routinely monitored, 659(8%) were suspected treatment failure and 379(4%) were repeat testers after suspected failure. The proportion of non-suppression was 22%, of which 876 (71%) were female. viral non-suppression proportion was 26% for suspected treatment failures and 23% for patients routinely monitored after suspected failure (23%). Factors associated with viral non-suppression included patient adhered to ARV treatment (aOR= 0.03, 95%CI = 0.23-0.36), aged <15 years (aOR = 0.22, 95%CI = 0.19-0.27) and young adolescents (aOR = 0.22 95%CI = 0.21-0.29), and patients receiving second-line regimens (aOR= 0.1, 95%CI = 0.03-0.17).Viral non-suppression was relatively low among patient on ART in Sierra Leone. ARV treatment adherence, being adult and patient receiving first-line treatment were protective factors against viral suppression. We recommend to close follow-up for children and to intensify adherence support for patients suspected with treatment failure.

Key word: Antiretroviral treatment (ART), viral non-suppression, HIV, Sierra Leone