Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015
Lilian Bulage1,&, Isaac Sewanyana2, Joseph Matovu1, Christine Kihembo1, Fred Nsubuga1, Gerald Pande1, Alex Riolexus Ario1, Charles Kiyaga2, Victoria Nankabirwa3
1Uganda Public Health Fellowship Program, Kampala, Uganda, 2Central Public Health Laboratories, Kampala, Uganda, 3Makerere University School of Public Health, Kampala, Uganda
Lilian Bulage, Uganda Public Health Fellowship Program, Kampala, Uganda
virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression.
a descriptive cross-sectional study was conducted using routinely collected
data from viral load testing samples from 100,678 HIV+ patients enrolled in
HIV care across the country between August 2014 and July 2015. Viral load testing
was conducted at the Central Public Health Laboratories in Kampala, Uganda.
We extracted data on socio-demographic, clinical and viral load testing results.
We defined virological 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 virological non-suppression.
majority of the patients (68%) were females. The overall non-suppression
rate was 11%. Second-time testers had a higher non-suppression rate than
first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5
years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR =
95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age
groups. Non-suppression rates were also higher among suspected treatment
failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence
levels < 85%
(35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR =
2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%,
= 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91)
had lower non-suppression rates than non-breastfeeding and non-pregnant women
virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics.
The 1st Uganda National Field Epidemiology Conference (Kampala)
The one-day Field Epidemiology Conference took place on December 11th, 2015 at Golf Course Hotel, Kampala. At this conference, Fellows presented investigations and epidemiologic studies they conducted since they joined the Fellowship in January 2015. Through these investigations and studies, important public health problems facing the nation were unveiled and strategies to address them proposed. This conference presented opportunity for national and international experts to discuss and propose solutions. This was the first Field Epidemiology Conference in Uganda and was attended by important dignitaries from the key partner institutions including Ministry of Health, UN agencies, Embassies, University officials, representatives from districts as well as other national and international delegates.
Dates: 11 Dec 2015
Venue: Golf Course Hotel, Kampala
Organizers: Ministry of Health and Makerere University School of Public Health
Contact person: Dr. Alex Riolexus Ario (email@example.com)