Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland
Kiran Jobanputra, Lucy Anne Parker, Charles Azih, Velephi Okello, Gugu Maphalala, Bernard Kershberger, Mohammed Khogali, Johnny Lujan, Annick Antierens, Roger Teck, Tom Ellman, Rose Kosgei, Tony Reid, Kiran Jobanputra, Lucy Anne Parker, Charles Azih, Velephi Okello, Gugu Maphalala, Bernard Kershberger, Mohammed Khogali, Johnny Lujan, Annick Antierens, Roger Teck, Tom Ellman, Rose Kosgei, Tony Reid
Abstract
Introduction: This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland.
Methods: This descriptive study used laboratory data from 7/5/2012 to 30/9/2013, which were linked with the national ART database to provide information on time on ART and CD4 count; information on enhanced adherence counselling was obtained from file review in health facilities. Multivariable logistic regression was used to explore the relationship between viral load, gender, age, time on ART, CD4 count and receiving (or not receiving) enhanced adherence counselling.
Results: From 12,063 patients undergoing routine viral load monitoring, 1941 (16%) had detectable viral loads. Children were more likely to have detectable viral loads (AOR 2.6, 95%CI 1.5-4.5), as were adolescents (AOR 3.2, 95%CI 2.2-4.8), patients with last CD4<350 cells/µl (AOR 2.2, 95%CI 1.7-2.9) or WHO Stage 3/4 disease (AOR 1.3, 95%CI 1.1-1.6), and patients on ART for longer (AOR 1.1, 95%CI 1.1-1.2). At retesting, 450 (54% of those tested) showed viral re-suppression. Children were less likely to re-suppress (AOR 0.2, 95%CI 0.1-0.7), as were adolescents (AOR 0.3, 95%CI 0.2-0.8), those with initial viral load> 1000 copies/ml (AOR 0.3, 95%CI 0.1-0.7), and those with last CD4<350 cells/µl (AOR 0.4, 95%CI 0.2-0.7). Receiving (or not receiving) enhanced adherence counselling was not associated with likelihood of re-suppression.
Conclusions: Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.
Conflict of interest statement
Competing Interests: The authors have declared that no competing interests exist.
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References
- WHO (2013) Consolidated guidelines on The use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a public health approach.
- Ma Y, Zhao D, Yu L, Bulterys M, Robinson ML, et al. (2010) Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China. Clin Infect Dis 50(2):264–71. 10.1086/649215
- Mutwa PR, Boer KR, Rusine J, Muganga N, Tuyishimire D, et al. (2014) Long-term Effectiveness of Combination Antiretroviral Therapy and Prevalence of HIV Drug Resistance in HIV-1-infected Children and Adolescents in Rwanda. Pediatr Infect Dis J;33(1):63–9. 10.1097/INF.0b013e31829e6b9f
- WHO (2013) HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV. Available: . Accessed: 2013 Dec 2
- Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, et al. (2014) Impact and programmatic implications of routine viral load monitoring in Swaziland. JAIDS [published ahead of print] 2014. Available: . Accessed 2014 Sep 7 10.1097/QAI.0000000000000224
- Nkambule R (2012) SHIMS (Swaziland HIV Incidence Measurement Survey)—findings.
- Strategic Information Department—Ministry of Health—Kingdom of Swaziland (2012) ART Program Annual Report 2012: 0–34.
- Greig JE, Cros PA, Mills C, Ugwoeruchukwu W, Etsetowaghan A, et al. (2013) Predictors of Raised Viral Load during Antiretroviral Therapy in Patients with and without Prior Antiretroviral Use : A Cross-Sectional Study. PLoS One;8(8):1–9. 10.1371/journal.pone.0071407
- Penazzato M (2013) WHO HIV Drug resistance surveillance in children less than 18 months old newly diagnosed with HIV: results from Swaziland and Zimbabwe. 5th International Workshop on HIV Paediatrics.
- Fox MP, Cutsem G Van, Giddy J, Maskew M, Keiser O, et al. (2012) Rates and predictors of failure of first-line antiretroviral therapy and switch to second-line ART in South Africa. J Acquir Immune Defic Syndr;60(4):428–37. 10.1097/QAI.0b013e3182557785
- Cheti E, Reid T, Kizito W, Obulutsa T, Kosgei R, et al. (2013) Is systematic viral load testing at six months of antiretroviral therapy followed by enhanced adherence counselling effective in reducing viral load in HIV-infected patients in an informal urban settlement in Nairobi, Kenya. In Press
- Van Griensven J, De Naeyer L, Uwera J, Asiimwe A, Gazille C, et al. (2008) Success with antiretroviral treatment for children in Kigali, Rwanda: experience with health center/nurse-based care. BMC Pediatr;8:39 10.1186/1471-2431-8-39
- Lee PK, Kieffer TL, Siliciano RF, Nettles RE (2006) HIV-1 viral load blips are of limited clinical significance. J Antimicrob Chemother;57(5):803–5. 10.1093/jac/dkl092
- Laprise C, Pokomandy A de (2013) Virologic failure following persistent low-level viremia in a cohort of HIV-positive patients: Results from 12 years of observation. Clin Infect Dis;1–21.10.1093/cid/cit529
- Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, et al. (2013) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Rev Esp Salud Publica;82(3):251–9.10.1097/EDE.0b013e3181577654
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