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. 2020 May 5;15(5):e0232576.
doi: 10.1371/journal.pone.0232576. eCollection 2020.

Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India

Chinmay Laxmeshwar  1 , Shrikala Acharya  2 , Mrinalini Das  1 , Padmaja Keskar  2 , Amar Pazare  3 , Nayana Ingole  3 , Preeti Mehta  3 , Pooja Gori  3 , Homa Mansoor  1 , Stobdan Kalon  1 , Pramila Singh  1 , Taanya Mathur  1 , Gabriella Ferlazzo  4 , Petros Isaakidis  4
Affiliations

Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India

Chinmay Laxmeshwar et al. PLoS One. .

Abstract

Background: Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Médecins Sans Frontières has provided routine VL measurements and EAC to PLHA on ART at King Edward Memorial (KEM) hospital, Mumbai since October-2016. This study aims to describe the initial VL results and impact of EAC on viral suppression and factors associated with initial viral non-suppression among patients with an initial detectable VL, in a cohort of patients tested between October-2016 and September-2018.

Methods: This is a descriptive study of PLHA on ART who received VL testing and EAC during October-2016 to September-2018. Log-binomial regression was used to identify factors associated with a high VL.

Results: Among 3849 PLHA who underwent VL testing, 1603(42%) were female and median age was 42 years (IQR:35-48). Majority were referred for routine testing (3432(89%)) and clinical/immunological failure (233(6%)). Overall, 3402(88%) PLHA had suppressed VL at initial testing. Among 3432 tested for routine monitoring, 3141(92%) had VL suppressed. Of 291 with VL>1000c/ml, 253(87%) received EAC and after repeat VL, 70(28%) had VL<1000c/ml. Among 233 referred for clinical/immunological failure, 122(52%) had VL>1000c/ml and 109 have been switched to second-line ART. CD4 count<500 (aOR-5.0[95%CI 3.8-6.5]), on ART for<5 years (aOR-1.5[1.1-2.0]) and age<15 years (aOR-5.2[3.0-8.9]) were associated with an initial VL>1000c/ml. Factors associated with follow-up VL suppression included EAC (p<0.05) and being on second-line ART (p<0.05).

Conclusion: Results from a routine VL program in public sector in India were encouraging and in line with UNAIDS 90-90-90 targets. Routine VL monitoring along with EAC resulted in early switch to alternative optimised regimens while also preventing unnecessary switches. Along with the vital scale up of routine VL monitoring, implementation of enhanced adherence strategies for patients with detectable viral load should be ensured.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. HIV viral-load testing cascade among people living with HIV/AIDS on ART at KEM hospital, Mumbai, India.
* Second Line Anti-retroviral therapy: # Lost to follow up.
See this image and copyright information in PMC

References

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    1. UNAIDS. 90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014. Available: http://www.unaids.org/Sites/Default/Files/Media_Asset/90-90-90_En_0.Pdf
    1. WHO. HIV / AIDS 7. 3 Monitoring response to ART and the diagnosis of treatment failure. [cited 13 Feb 2018]. Available: http://www.who.int/hiv/pub/guidelines/arv2013/art/artmonitoring/en/index...

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