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Observational Study
. 2019 Oct 24;14(10):e0219415.
doi: 10.1371/journal.pone.0219415. eCollection 2019.

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Patience Atuhaire  1 , Sherika Hanley  2 , Nonhlanhla Yende-Zuma  3 , Jim Aizire  4 , Lynda Stranix-Chibanda  5 , Bonus Makanani  6 , Beteniko Milala  7 , Haseena Cassim  8 , Taha Taha  4 , Mary Glenn Fowler  9
Affiliations
Observational Study

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Patience Atuhaire et al. PLoS One. .

Abstract

Background: Despite recent efforts to scale-up lifelong combination antiretroviral therapy (cART) in sub-Saharan Africa, high rates of unsuppressed viremia persist among cART users, and many countries in the region fall short of the UNAIDS 2020 target to have 90% virally suppressed. We sought to determine the factors associated with unsuppressed viremia (defined for the purpose of this study as >200 copies/ml) among sub-Saharan African women on lifelong cART.

Methods: This cross-sectional analysis was based on baseline data of the PROMOTE longitudinal cohort study at 8 sites in Uganda, Malawi, Zimbabwe and South Africa. The study enrolled 1987 women living with HIV who initiated lifelong cART at least 1-5 years ago. Socio-demographic, clinical, and cART adherence data were collected. We used multivariable Poisson regression with robust variance to identify factors associated with unsuppressed viremia.

Results: At enrolment, 1947/1987 (98%) women reported taking cART. Of these, HIV-1 remained detectable in 293/1934 (15%), while 216/1934 (11.2%) were considered unsuppressed (>200 copies/ml). The following factors were associated with an increased risk of unsuppressed viremia: not having household electricity (adjusted prevalence risk ratio (aPRR) 1.74, 95% confidence interval (CI) 1.28-2.36, p<0.001); not being married (aPRR 1.32, 95% CI 0.99-1.78, p = 0.061), self-reported missed cART doses (aPRR 1.63, 95% CI 1.24-2.13, p<0.001); recent hospitalization (aPRR 2.48, 95% CI 1.28-4.80, p = 0.007) and experiencing abnormal vaginal discharge in the last three months (aPRR 1.88; 95% CI 1.16-3.04, p = 0.010). Longer time on cART (aPRR 0.75, 95% CI 0.64-0.88, p<0.001) and being older (aPRR 0.77, 95% CI 0.76-0.88, p<0.001) were associated with reduced risk of unsuppressed viremia.

Conclusion: Socioeconomic barriers such as poverty, and individual barriers like not being married, young age, and self-reported missed doses are key predictors of unsuppressed viremia. Targeted interventions are needed to improve cART adherence among women living with HIV with this risk factor profile.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart showing numbers from PROMISE trial to PROMOTE study.
Fig 2
Fig 2. Reasons for missing ART dose.
See this image and copyright information in PMC

References

    1. WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach: World Health Organization; 2016. - PubMed
    1. UNAIDS. Global HIV & AIDS Statistics Update 2019 UNAIDS: Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019.
    1. UNAIDS. Global HIV/AIDS statistics facts sheet: UNAIDS; 2018. [July 2018].
    1. Nachega JB, Uthman OA, Anderson J, Peltzer K, Wampold S, Cotton MF, et al. Adherence to antiretroviral therapy during and after pregnancy in low-, middle and high income countries: a systematic review and meta-analysis. AIDS (London, England). 2012;26(16):2039. - PMC - PubMed
    1. Haberer JE, Sabin L, Amico KR, Orrell C, Galárraga O, Tsai AC, et al. Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations. Journal of the International AIDS Society. 2017;20(1):21371 10.7448/IAS.20.1.21371 - DOI - PMC - PubMed

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