Factors associated with viral load re-suppression after enhanced adherence counseling among people living with HIV with an initial high viral load result in selected Nigerian states

Abstract

The WHO recommends monitoring viral load (VL) to gauge ART efficacy among People Living with HIV (PLHIV). Low suppression rates persist in low- and middle-income countries due to poor adherence. Enhanced Adherence Counseling (EAC) aims to improve adherence and treatment outcomes. This study, part of the Reaching Impact Saturation and Epidemic Control (RISE) project in Nigeria, analyzes factors affecting viral re-suppression post-EAC. It aims to inform clinical decisions and improve PLHIV health outcomes in the country. This was a retrospective analysis of a de-identified client-level dataset of unsuppressed VL clients who were current on treatment at the end of June 2022 and subsequently enrolled in the EAC program. A log-binomial regression model was used to report crude and adjusted risk ratio with 95% Confidence Intervals (95% CI) and a p-value of 0.05 to determine the association between clinical characteristics and suppression of VL post-EAC in the RISE program (July 2021 to June 2022). A total of 1607 clients with initial high VL who completed EAC were included in this analysis out of which 1454 (91%) were virally suppressed. The median time to completion of EAC was 8 weeks and the median time for post EAC VL test was 8 weeks. Following EAC, PLHIV in the 10-19 years age band were 10% more likely to be re-suppressed (ARR: 1.10; 95% CI 1.01 to 1.19). In addition, there was a 50% reduced likelihood of viral re-suppression among PLHIV on second-line regimens compared to PLHIV on first-line regimens (ARR: 0.50; 95% CI 0.41 to 0.62). Findings show that Age and ART regimen were significant predictors of VLS. More targeted outreach of EAC amongst second-line regimens and ages 10 and above is necessary to ensure better VLS within these groups.