Abstract:

Viral load (VL) determination is the standard to assess the effectiveness of Anti-retroviral Therapy (ART) in people living with HIV (PLWIV). According to Cameroon national ART guidelines, VL determination in PLHIV should be done after six months of starting ART and then every 12 months. Unsuppressed VL occurs when ARV’s fails to suppress viral load and is associated with decreased survival and increased risk of HIV transmission, morbidity, and mortality. A sequential and exploratory facility and community-based cross-sectional study was conducted on 391 patients on first-line ART in public health facilities in the East region of Cameroon from January 2021 to January 2022. Structural questionnaires and a review of medical records were the data source of the study. SPSS version 26 was used for data analysis, and Chi-squared (χ2) tests to explore the associations between outcome variables and the independent variables. Logistic regression analysis was performed to identify predictors and facilitators of high viral load at 95% CI and P < 0.05 statistically significant level. Age, marital status, Occupation, food insecurity, switching regimen, and non-adherence were found to be the predictors of high viral load, while the distance from the clinic, medication side effects, substance use, poverty, missing clinical appointment or ARV doses, knowledge on ARV and health personnel attitudes were found to be facilitators. Unsuppressed viral load among PLWH in the East region of Cameroon is cause by predictors and facilitators. Therefore, need for targeted interventions for patients on ART who are at high risk of becoming virally unsuppressed.

References:

[1] Mellors JW, Rinaldo Jr CR, Gupta P, White RM, Todd JA, Kingsley LA. 1996, Prognosis in HIV-1 Infection Predicted by the Quantity of Virus in Plasma. Scienc, (272), 1167-1170, https://pubmed.ncbi.nlm.nih.gov/8638160.

[2] May M, Boulle A, Phiri S, Messou E, Myer L, Wood R, et al., 2010, Prognosis of patients with HIV-1 infection starting anti-retroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes. Lancet. 376(9739):449-57, https://pubmed.ncbi.nlm.nih.gov/20638120.

[3] Ministry of Public Health. Cameroon Country Operational Plan (COP 2021) Yaounde: https://www.state.gov/wp-content/uploads/2021/09/Cameroon_SDS_Final-Public_Aug-11-2021.pdf.

[4] UNAIDS. UNAIDS 2021 epidemiological estimates. Geneva https://www.unaids.org/en/resources/fact-sheet.

[5] UNAIDS. Who we are.; 2021. 23/09/2021: https://www.unaids.org/en/whoweare/about.

[6] UNAIDS. Cameroon UNAIDS Factsheet. 2020, Geneva, https://data.unaids.org/publications/fact-sheets01/cameroon_en.pdf.

[7] Camphia. Cameroon Population-based HIV Impact Assessment Camphia 2017. Yaounde, https://phia.icap.columbia.edu/wp -content/uploads/2018/07/3471CAMPHIA_Cameroon-SS_A4_v13_requests_7.25.18.pdf.

[8] SAFAIDS. Prevention Gap Report, 2016. http://catalogue.safaids.net/publications/prevention-gap-report.

[9] United Nations General Assembly. 2016, Prevention Gap Report. Geneva, https://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf.

[10] World Health Organisation. 2014, Current issues, HIV/AIDS, Geneva, 2014 November, https://www.who.int/health-topics/hiv-aids#tab=tab_1.

[11] President Emergency Plan for AID Relief (PEPFAR).,2016, Cameroon Country Operational Plan COP 2016 Strategic Direction Summary., https://www.state.gov/wp-content/uploads/2019/08/Cameroon-11.pdf.

[12] Haber N, Pillay D, Porter K, Barnighausen T. 2016, Constructing the cascade of HIV care: methods for measurement. Current Opinion in HIV and AIDS. 11(1):102-8 https://pubmed.ncbi.nlm.nih.gov/26545266/.

[13] Druyts, Dybul M, Kanters S, Nachega J, Birungi J, Ford, et al. Male sex and the risk of mortality among individuals enrolled in anti-retroviral therapy programs in Africa: a systematic review and meta-analysis. NIH. 2013.

[14] Emagnu, A, Abay Z, Bulti, AB, Animut Y., 2020 Determinants of Virologic Failure among Adult HIV Patients on First-Line Antiretroviral Therapy at Waghimra Zone, Northern Ethiopia: A Case-Control Study. Hindawi., 1-8, https://www.hindawi.com/journals/aph/2020/1929436/.

[15] Rangarajan S, Donn C, Giang LT, Bui HH, Tou BP, Danh TT, et al, 2016, Factors associated with HIV viral load suppression on anti-retroviral therapy in Vietnam. Journal of Virus Eradication., 2(2): 94–101, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965252/.

[16] Rupérez M, Pou C, Maculuve S, Cedeño S, Luis L, Rodríguez J, et al. 2016, Determinants of virological failure and antiretroviral drug resistance in Mozambique, 70(9):2639-47 J Antimicrob Chemother, https://pubmed.ncbi.nlm.nih.gov/26084302/.

[17] Wakooko P, Gavamukulya, Y, Wandabwa JN. 2020, Viral load Suppression and Associated Factors among HIV Patients on Antiretroviral Treatment in Bulambuli District, Eastern Uganda: A Retrospective Cohort Study. Infect Dis (Auckl). 13, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656881/.

[18] Donnelly CA, Bartley, LM, Ghani AC, Le Fevre AM, Kwong GP, Cowling BJ, et al. 2005, Gender difference in HIV-1 RNA viral loads. Pub Med., 6(3):170-8, https://pubmed.ncbi.nlm.nih.gov/15876283/.

[19] Srasuebkul P, Ungsedhapand C, Ruxrungtham K, Boyd MA, Phanuphak P, Cooper DA, et al. 2007, Predictive factors for immunological and virological endpoints in Thai patients receiving combination anti-retroviral treatment. Pub Med., 8(1):46-54, https://pubmed.ncbi.nlm.nih.gov/17305932/.

[20] Maulsby CH, Ratnayake A, Hesson, D, Mugavero, MJ, Latkin CA., 2020, A Scoping Review of Employment and HIV. AIDS Behav, 2020, 29(10); 2942-2955. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716244/.

[21] Fishel JD, Bradley SE, Young PW, Mbofana F, Botão C., 2011, HIV among Couples in Mozambique: HIV Status, Knowledge of Status, and Factors Associated with HIV Serodiscordance. ICF International. https://dhsprogram.com/pubs/pdf/FA71/FA71.pdf.

[22] Shanfang Q, Jingzhen L, Hong Z, Di W, Qing L, Xue P, et al., 2021, Predictive factors of viral load high-risk events for virological failure in HIV/AIDS patients receiving long-term antiviral therapy. BMC Infectious Diseases, 448(2021) https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06162-z.

[23] Billioux VG, Grabowski MK, Ssekasanvu J, Reynolds, SJ, Berman A, Bazaale J, et al., 2018, HIV viral suppression and geospatial patterns of HIV anti-retroviral therapy treatment facility use in Rakai, Uganda. AIDS., 32(6); 819-824 819-824, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854528/.

[24] Dear N, Esber, A, Iroezindu M, Bahemana E, Kibuuka H, Maswai J, et al. 2022, Routine HIV clinic visit adherence in the African Cohort Study. BMC.1(2022), https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-021-00425-0.

[25] Sadikalmahdi H, Belachew T, Nezif H. 2016, Nutritional status, and its effect on treatment outcome among HIV infected clients receiving HAART in Ethiopia: a cohort study. BMC, 32(2016). https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-016-0116-9.

[26] Abba A, Fokam J, Kamgaing RS, Yimga JF, Ka’e CA, Nka AD, et al. 2021, Correlation between the immuno-virological response and the nutritional profile of treatment-experienced HIV- infected patients in the East region of Cameroon. Plos One. 1(2021), https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229550.

[27] De Boni RB, Peratikos MB, Sphepherd BE, Cortes C, Padett D, Gatuzzo E. 2018, Is substance use associated with HIV cascade outcomes in Latin America? PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194228.

[28] Korthuis TP, Edelman J. 2018, Substance use and the HIV care continuum: important advances. BMC 13(2018), https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-018-0114-4.

[29] Shoko, C, Chikobvu D, Bessong PO. 2020, Effects of Antiretroviral Therapy on CD4+ Cell Count, HIV Viral Load and Death in a South African Cohort: A Modelling Study. Pak J Biol Sci.23(4) 542-541, https://pubmed.ncbi.nlm.nih.gov/32363840/.

[30] Rangarajan S, Colby DJ, Giang LT, Bui DD, Nguyen HH, Tou BP, et al. 2016, Factors associated with HIV viral load suppression on anti-retroviral therapy in Vietnam. Elsevier., 2(2); 94-101, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965252/.

[31] Cochran WG (1977). Sampling Techniques, 3rd edition, New York: Johnson Wiley and Sons, https://www.scirp.org/(S(i43dyn45teexjx455qlt3d2q))/reference/ReferencesPapers.aspx?ReferenceID=1390266.