Abstract:

Background: Namibia enrolled 93% of HIV patients into ART programme.

Objectives: To evaluate adherence and viral load completion accomplishments after ART initiation.

Methods: Retrospective cohort study using quantitative method. SPSS was used to analyze the data. Three sets of analyses reported. First compare the age, sex, CD4 and adherence to ART. Then patients with ≥95% adherence to those <95% and viral suppression at 6 and 12 months.

Results: About 69% adhered to treatment at least 95%. Of the 614 patients with viral load records, 73.3% (n=450) had viral suppression at 6 months. At 12 months, a total of 518 with viral load records,85.9% had viral suppression. Among the patients with adherence of at least 95% at six months, 75.2% had viral suppression. At 12 months, 89.4% of patients who adhered at least 95% of ART had viral suppression.

In multivariate binary regression, the study revealed that those who adhered more than 95%, were 1.65 times more likely to suppress the virus compared to those who did not (p=0.029). The results further showed that having CD4 > 200 at ART initiation was likely to be associated with viral suppression (OR=1.55, 95% CI 1.03-2.33).

Conclusions: The adherence to ART, viral load accomplishments, viral suppression did not reach the expected outcomes, targets set by UNAIDS. Although, close to 90% of patients at 12 months showed viral suppression, the number of patients checked for viral load were far from 90% of patients (about 54.5%) ever started on ART.

Keywords: HIV; Antiretroviral Therapy; ART adherence; viral load completion accomplishments, viral suppression, UNAIDS targets.

References:

[1].     Adriano JA, Dorado I, Brito AM & da Silva CAL (2015). Factors associated with non-adherence to antiretroviral therapy in adults with AIDS in the first six months of treatment in Salvador, Bahia State, Brazil. Cad. Saúde Pública, Rio de Janeiro, 31(6):1-11, jun, 2015.

[2].     Barnabas RV et al (2014). Initiation of ontiretroviral therapy and viral suppression after home HIV testing and counselling in KwaZulu-Natal, South Africa, and Mbarara district, Uganda: a prospective, observational intervention study. Lancet HIB. 2014 Nov;1(2): e68-e76.

[3].     Beaglehole, R., Bonita, R & Kjellstron, T (1993). Basic Epidemiology. Geneva: WHO.

[4].     Beer L., Heffelfinger J., Frazier E et al (2012). Use of and Adherence to Antiretroviral Therapy in a Large U.S. Sample of HIV-infected Adults in Care, 2007-2008.The Open AIDS Journal, 2012, 6, (Suppl 1: M21) 213-223.

[5].     Berheto T.M., Haile D.B. & Mohammed S. (2014). Predictors of Loss to follow-up in Patients Living with HIV/AIDS after HIV/AIDS after Initiation of Antiretroviral Therapy. N AM J Med Sci.2014 Sep; 6(9):453-459doi: 10.4103/1947-2714.141636.

[6].     Beyena KA, Gedif T, Gebre-Mariam T, Engidawork E (2009) Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia, Pharmacoepidemiology, and Drug Safety 18:1007-1015.

[7].     Carter M (2017). Early ART highly acceptable and achieves excellent rates of viral suppression among young South African women. Available at www.aidsmap.com/Early-ART-highly...and...of-viral-suppression.../3133122/.

[8].     Garret N et al (2017). Acceptability of early antiretroviral therapy among South African women. AIDS Behav, online edition. DOI: 10.1007/s10461-017-1729-2(2017).

[9].     Chaiyachatia KH, Ogbuojib O, Priceb M, Sutharc AB, Negussiec EK & Ba¨rnighausen T (2014). Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. S200 AIDS 2014, Vol 28 (Suppl 2).

[10]. Centers for Disease Control and Prevention (2011). Introduction to Program Evaluation for Public Health Programs: A Self-Study Guide. Atlanta, GA: Centers for Disease Control and Prevention.

[10].Centers for Disease Control and Prevention (2012). Linkage to and retention in HIV Medical Care. Available at http://www.cdc.gov/hiv/prevention/programs/pwp/linkage.html. Accessed on June 9, 2016.

[11]. Chrhartishvili N., Rukhadze N., Svanidzel et al (2014). Evaluation of multiple measures of antiretroviral adherence in the Eastern European country of Georgia.

[12]. Collins English Dictionary (2016). Adherence definition and meaning/Collins English Dictionary. Available at https://www.collinsdictionary.com/dictionary/english/adherence. Accessed on May 20, 2017.

[13]. Dibaba B & Hussein M (2016). Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV/AIDS in Arsi Zone, Oromia. ISSN 2155-6113. Journal of AIDS & Clinical Research.

[14]. Ejigu MA, Mohammed MA (2014). Anti-retroviral therapy adherence and its determinants among adult patients living with HIV/AIDS in South West Ethiopia: A facility-based cross-sectional study, Gaziantep Med J20:52-58.

[15]. Eller LS (2009). Adherence, Resistance and Antiretroviral Therapy. Online available: https://aidsetc.org/sites/default/files/resources-files/nynj-nurse-mod2-09-ppt.

[16]. Elul B. et al (2013). High Levels of Adherence and Viral Suppression in a Nationally Representative Sample of HIV-Infected Adults on Antiretroviral Therapy for 6, 12 and 18 Months in Rwanda. Online available: https://doi.org/10.1371/journal.pone.0053586. Access October 11, 2017.

[17]. Eyassu M.A., Mothiba T.M. & Mbambo-kekana N. P. (2016). Adherence to antiretroviral therapy among HIV and AIDS patients at the Kwa-Thema clinic in Gauteng Province, South Africa. Afr J Prim Health Care Fam Med. 2016;8(2):924.

[18]. Fagbamigbe A.F., Adebayo S.B. & Idomudia (2016). Marital status and HIV prevalence among women in Nigeria; Ingredients for evidence-based programming. International Journal of Infectious Diseases. Volume 48, July 2016, Pages 57-63.

[19]. Fox M.P., Sanne I.M., Conradie F., Zeinecker J., Orrel C., Ive P., Rassool M., Dehlinger M., Van der Horst, James McIntyre & Wood R. (2011). Initiating Patients on ART at CD4 above 200 in Associated with Improved Treatment Outcomes in South Africa. AIDS. 2010 Aug 24:24(13):2041-2050 doi 10.1097/QAD.Ob013e32833c703e.

[20]. Gesesew H.A., Ward P., Woldemichael K. & Mwanri L. (2016). Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015. Online available https://doi.org/10.137/journal.pone.0179533 access on October 10, 2017.

[21]. Hosseinipour MC, Gupta RK, Van Zyl G, Eron JJ & Nachega JB (2013). Emergence of HIV Drug Resistance During First- and Second-Line Antiretroviral Therapy in Resource-Limited Settings. J Infect Dis. 2013 Jun 15; 207(Suppl 2): S49–S56. doi: 10.1093/infdis/jit107.

[22]. J Int AIDS Soc. 2014; 17(1): 18885.Published online 2014 Apr 9. doi: 10.7448/IAS.17.1.18885.

[23]. Eltom MA, Jemal A, Mbulaiteye SM, Biggar RJ (2002). Trends in Kaposi's sarcoma and non-Hodgkin's lymphoma incidence in the United States from 1973 through 1998. J Natl Cancer Inst. 2002; 94:1204–1210.

[24]. Kalichman ST et al (2015). Viral Suppression and Antiretroviral Medication Adherence Among Alcohol Using HIV Positive Adults. Int J Behay Med.2014; 21(5):811-820. Doi:10.1007/s12529-013-9353-7.

[25]. Karl P & Supa P (2013). Socioeconomic Factors in Adherence to HIV Therapy in Low- and Middle-Income Countries. Journal of Health Population and Nutrition, June 1, 2013.

[26]. Kim S., Gerver SM., Sarah Fidler S & Ward H (2014). Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014 Aug 24; 28(13): 1945–1956. Published online 2014 Jul 30. doi: 10.1097/QAD.0000000000000316.

[27]. HIV/AIDS Glossary? Viral Load/Definition/AIDS info. Available at https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/877/viral-load. Accessed on May 20, 2017.

[28]. Koss CA et al (2017). Suppression and Retention in Care up to 5 Years After Initiation of Lifelong ART During Pregnancy (Option B+) in Rural Uganda. JAIDS Journal of Acquired Immune Deficiency Syndromes: 01March2017-Volume74-Issue3-p279-284.

doi: 10.1097/QAI.0000000000001228Epidemiology.

[29]. Kyser M1, Buchacz K, Bush TJ et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011 May;23(5):601-11. doi: 10.1080/09540121.2010.525603.

[30]. Lahuerta M., Ue F., Hoffman et al (2013). The Problem of Late ART initiation in Sub-Saharan Africa: A Transient Aspect of Scale-up or a Long-term Phenomenon? J Health Care Poor Underserved. 2013 Feb; 24(1): 359–383. doi: 10.1353/hpu.2013.0014.

[32]. Mitiku H, Abdosh T & Teklemariam Z. (2013). Factors Affecting Adherence to Antiretroviral Treatment in Harari National Regional State, Eastern Ethiopia. ISRN AIDS Volume 2013 (2013), Article ID 960954, 7 pages http://dx.doi.org/10.1155/2013/960954.

[33]. Momo A. & Suleiman I.A. (2016). Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria. Pharm Pract (Granada). 2016 Jan-Mar; 14(1):631.

[34]. Mulugira A et a (2017). High levels of viral suppression among East African HIV-infected women and men in serodiscordant partnerships initiating antiretroviral therapy with high CD4 counts and during pregnancy. AIDS Res Hum Retroviruses 2017 Sep 13.

[35]. Namibia Statistics Agency - Government of the Republic of Namibia (2014). 2011 Namibian Population and housing census 2011. NAM_NSA_PHC_2011_V01_PUMS. Windhoek-Namibia.

[36]. Namibia Ministry of Health and Social Services (MoHSS). (2014). surveillance Report of the 2014 National HIV Sentinel Survey. Windhoek. Namibia.

[37]. Namibia Ministry of Health and Social Services (MoHSS) and ICF International (2014). The Namibian Demographic and Health Survey 2013. Windhoek, Namibia, and Rockville, Maryland, USA: MoHSS and ICF International.

[38]. Namibia Ministry of Health and Social Services (MoHSS). (2013). Report on the 2010 HIV Drug Resistance Survey. Windhoek. Namibia.

[39]. Namibia Ministry of Health and Social Services (MoHSS). (2011/12). National Strategic Framework for HIV and AIDS 2011/12. Windhoek. Namibia.

[40]. Namibia Ministry of Health and Social Services (MoHSS). (2016). National Guidelines for Antiretroviral Therapy. Fifth edition 2016. Windhoek. Namibia.

[41]. Nuwagaba-Biribonwoha H et al (?). Factors Associated with Non-Adherence to Antiretroviral Therapy among Patients Attending HIV Care and Treatment Clinics. Online available: http://www.lapac.org/AdherenceConference/presentations/ADH7 80082.pdf.

[42]. Obua C, Kayiwa J, Waako P, Tomson G, Balidawa H, Chalker J, Ross-Degnan D & Rolf Wahlstrom R (2014). Improving Adherence to Antiretroviral Treatment in Uganda with a low-resource-Facility-based Intervention. Global Health Action. vol7 (2014).

[43]. Ortblad K.F., Lozano R., & Murray C.J.L (2013). The burden of HIV: insights from the Global Burden of Disease Study 2010. AIDS. 2013 Aug 24; 27(13): 2003–2017.

[44]. Rangarajan et al (2016). Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam. J Virus Erad. 2016 Apr 1; 2(2):94-101. PubMed.gov.

[45]. Reda AA & Biadgilign S (2012). Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa. AIDS Research and Treatment.

[46]. Volume 2012 (2012), Article ID 574656.

[47]. Samji H, Censon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al. (2013). Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United.

[48]. States and Canada. PLoS ONE 8(12): e81355.doi: 10.1371.pone.0081355.

[49]. San Lio MM., Carbini R., Germano P & al (2008). Evaluating Adherence to Highly Active Antiretroviral Therapy with Use of Pill Counts and Viral Load Measurement in the Drug Resources Enhancement against AIDS and Malnutrition Program in Mozambique. Oxford Journals Medicine & Health Clinical Infectious Diseases Volume 46, Issue 10Pp. 1609-1616.

[50]. Schaecher K.L. (2013). The Importance of Treatment Adherence in HIV. Available at http://www.ajmc.com/journals/supplement/2013/a472...hiv/a472_sep13_schaecher_s231. Accessed on November 11, 2017.

[51]. Silva MC, Ximenes RA, Miranda Filho DB, Arraes LW, Mendes M, Melo AC, et al. Risk-factors for non-adherence to antiretroviral therapy. Rev Inst Med Trop São Paulo 2009; 51:135-9.

[52]. Simoni JM, PhD, Amico KR, Pearson CR & Malow R (2008). Strategies for Promoting Adherence to Antiretroviral Therapy: A Review of the Literature. Department of Psychology, University of Washington, Campus Box 351525, Seattle, WA 98195, USA.

[53]. Thompson M (2011). Challenges of Improving Adherence to HIV Therapy. Am Fam Physician. 2011 Feb 15;83(4):375-379.

[54]. Tsondai PR, Wilkinson LS, Grimscrud A, Mdlalo PP, Ullauri A & Boulle A (2017). High rates of retention and viral suppression in the scale-up of antiretroviral therapy adherence clubs in Cape Town, South Africa. Journal of the International AIDS Society 2017, 20:21649. Online available: http://www.jiasociety.org/index.php/jias/article/view/21649| http://dx.doi.org/10.7448/IAS.20.5.21649.

[55]. UNAIDS (2014). UNAIDS Report 2014. Geneva, Switzerland.

[56]. UNAIDS (2016). UNAIDS Report 2016. Geneva, Switzerland.

[57]. US Department of Health and Human Services (2014). Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults AND Adolescents. online available: https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/30/adherence-to-art. Access October, 2017.

[58]. WHO (2006). Patients monitoring guidelines for HIV care and Antiretroviral Therapy. World Health Organization 20, avenue Appia CH-1211 Geneva 27 Switzerland.

[59]. WHO (2006). From access to adherence: the challenges of antiretroviral treatment. World Health Organization 20, avenue Appia CH-1211 Geneva 27 Switzerland.

[60]. WHO (2012). Patient evaluation and antiretroviral treatment for adults and adolescents. WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark.