Factors associated with viral non-suppression among HIV-positive patients on antiretroviral therapy in Sierra Leone, January 2018–June 2019

Abstract

Despite the growing number of people on an/retroviral therapy (ART), there is limited informa/on about viral non-suppression and its determinants among HIV-posi/ve individuals enrolled in HIV care in many resource-limited seTngs. We es/mated the propor/on of virally non-suppressed pa/ents, and iden/fied the factors associated with viral non-suppression. We conducted a descrip/ve cross-sec/onal study using rou/nely collected program data from viral load (VL) samples collected across the country for tes/ng at the Central Public Health Reference Laboratories (CPHRL) in Sierra Leone. Data were generated between January 2018 and December 2019. We extracted data on socio-demographic, clinical and VL tes/ng results. We defined viral 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 logis/c regression to iden/fy factors associated with viral non-suppression. This study consisted of 8,657 pa/ents, of whom 4224 (74%) were male, and 94.3% were older than 15 years old. Of the total, 7619 (88%) pa/ents rou/nely monitored, 659(8%) were suspected treatment failure and 379(4%) were repeat testers ager suspected failure. The propor/on of non-suppression was 22%, of which 876 (71%) were female. viral non-suppression propor/on was 26% for suspected treatment failures and 23% for pa/ents rou/nely monitored ager suspected failure (23%). Factors associated with viral non-suppression included pa/ent adhered to ARV treatment (aOR= 0.03, 95%CI = 0.23-0.36), aged <15 years (aOR = 0.22, 95%CI = 0.19-0.27) and young adolescents (aOR = 0.22 95%CI = 0.21-0.29), and pa/ents receiving second-line regimens (aOR= 0.1, 95%CI = 0.03-0.17).Viral non-suppression was rela/vely low among pa/ent on ART in Sierra Leone. ARV treatment adherence, being adult and pa/ent receiving first-line treatment were protec/ve factors against viral suppression. We recommend to close follow-up for children and to intensify adherence support for pa/ents suspected with treatment failure.