Viral Load Suppression Among HIV Infected Adults On Antiretroviral Treatment In Rural Settings Of The Centre Region Of Cameroon: A Retrospective Cohort Study
Abstract:
The Joint United Nations Program on HIV/AIDS
(UNAIDS) set ambitious targets known as the 95-95-95 goals, aiming for 95% of
people living with HIV to know their status, 95% of those diagnosed to be on
sustained ART, and 95% of those on ART to have viral suppression by 2030. This
underscores the significance of viral load (VL) monitoring and suppression as
crucial components of the HIV care continuum towards reaching epidemic control.
This study was meant to explore viral load suppression among HIV-infected adults
on ART in the rural areas of the Centre Region of Cameroon. We conducted a
retrospective cohort study on all HIV-infected adults who were initiated on ART
between June 2020 and May 2021 in ten rural ART clinics. Patients’ medical
records were reviewed for data collection. Of the 2 591 HIV-infected adults on
ART whose medical files were reviewed, 1 727 (66.7%) had documented viral load
(VL) results at 12 months post-ART initiation giving a viral load coverage of
66.7%. Among the 1,727 documented VL, the proportion of participants that
achieved viral suppression (viral load <1000 copies/mL) was 1 654,
representing 95.8%. Occupation at initiation (aOR: 0.416, 95% CI: 0.196–0.885,
p=0.023) and disclosure of HIV status to partners (cOR: 0.557, 95% CI:
0.317–0.978, p=0.042) emerged as significant predictors of VL suppression.
Findings from this study show that as HIV care continues to evolve,
interventions tailored to individual needs and context-specific challenges
should be prioritized to optimize treatment outcomes.
References:
[1] UNAIDS. UNAIDS Data., 2023,
Geneva: Joint United Nations Programme on HIV/AIDS. https://www.unaids.org/sites/default/files/media_asset/data-book-2023_en.pdf.
[2] UNAIDS., 2023, HIV/AIDS Key facts. https://www.who.int/news-room/fact-sheets/detail/hiv-aids.
[3] UNAIDS., 2020, Global AIDS Update — Seizing the
moment — Tackling entrenched inequalities to end epidemics. https://www.unaids.org/en/resources/documents/2020/global-aids-report.
[4] UNAIDS., 2014, Fast-Track: Ending the AIDS Epidemic
by 2030. https://www.unaids.org/en/resources/documents/2014/JC2686_WAD2014report
[5] Ministry of Public Health., 2022, CAMEROON Country
Operational Plan (COP) , 2022, Strategic Direction Summary. Yaoundé, May 10,
2022. https://www.state.gov/wp-content/uploads/2022/09/Cameroon-COP22-SDS.pdf.
[6] Cameroon Demographic and Health Survey (DHS)., 2018,
Cameroon 2018 Demographic and Health Survey Summary Report. https://dhsprogram.com/pubs/pdf/SR266/SR266.pdf.
[7] Ministry of Public Health., 2016, Cameroon National
AIDS Control Committee. (NACC) 2016 Annual reports. http://onsp.minsante.cm/sites/default/files/publications/249/rapport_annuel_cnls_2016-2017.pdf.
[8] Ministry of Public Health., 2015, National
Guidelines on the Prevention and Management of HIV in Cameroon. https://www.childrenandaids.org/sites/default/files/201805/Cameroon_Nat%20Guidelines%20HIV_2015.pdf
[9] Cameroon Population-based HIV Impact Assessment
(CAMPHIA)., 2017, The Cameroon Population-based HIV Impact Assessment
(CAMPHIA), a household-based national survey, was conducted between July 2017
and February 2018 in order to measure the status of Cameroon’s national HIV
response. https://phia.icap.columbia.edu/wp-content/uploads/2021/04/53059-CAMPHIA-Report_EN_Web_V4.pdf.
[10] CNLS., 2016, Annual report. Assessed on 12th June
2023. Available at: http://wwwcnlscm.
[11] Ministry of Public Health Cameroon., 2021, Cameroon
National Strategic Plan For fight against HIV/AIDS and STIs 2021-2023. https://www.prepwatch.org/resources/cameroon-national-strategic-plan-for-fight-against-hiv-aids-and-stis-2021-23/.
[12] Lebelonyane R, Bachanas P, Block L, Ussery F,
Alwano MG, Marukutira T, et al., 2021, To achieve 95–95–95 targets, we must
reach men and youth: high level of knowledge of HIV status, ART coverage, and
viral suppression in the Botswana Combination Prevention Project through
universal test and treat approach. PLoS ONE, 16(8), e0255227. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255227.
[13] Koss C. A, Natureeba P, Kwarisiima D, Ogena M,
Clark T. D, Olwoch P, et al., 2017, Viral suppression and retention in care up
to 5 years after initiation of lifelong ART during pregnancy (option B+) in
rural Uganda. J Acquir Immune Defic Syndr, 74(3), 279–84. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303140/pdf/nihms825580.pdf.
[14] Maskew M, Brennan A. T, Westreich D, McNamara L,
MacPhail A. P, Fox M. P., 2017, Gender differences in mortality and CD4 count
response among virally suppressed HIV-positive patients. J Int AIDS Soc, 20(1),
1-7. https://www.liebertpub.com/doi/full/10.1089/jwh.2012.3585.
[15] Kipp, W., Alibhai, A., Saunders, L. D.,
Senthilselvan, A., Kaler, A., Konde-Lule, J., . & Rubaale, T., 2010, Gender
differences in antiretroviral treatment outcomes of HIV patients in rural
Uganda. AIDS care, 22(3), 271-278. https://www.tandfonline.com/doi/abs/10.1080/09540120903193625.
[16] Mutevedzi P. C, Lessells R. J, Rodger A. J, Newell
M. L, the Africa Centre for Population Health., 2019, Association of age with
mortality and virological and immunological response to antiretroviral therapy
in rural South African adults. PLoS ONE, 14(6), e0218277. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0021795.
[17] Boyer, S, March, L, Kouanfack C, Laborde-Balen G,
Marino P, Aghokeng A, et al., 2017, Monitoring of HIV viral load, CD4 cell
count, and clinical assessment versus clinical monitoring alone for
antiretroviral therapy in low-resource settings (Stratall ANRS 12110/ESTHER): a
cost-effectiveness analysis. Lancet Infect Dis, 17(5), 511-520. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70073-2/fulltext.
[18] Mbuagbaw L, Medley N, Darzi A. J, Richardson M,
Habiba Garga K., 2018, Health system and community level interventions for
improving antiretroviral therapy adherence among HIV-positive adolescents: A
systematic review. PLoS ONE, 13(8), e0200821. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010994.pub2/full.
[19] Decroo, T, Rasschaert, F, Telfer, B, Remartinez, D,
Laga, M, Ford N., 2011, Community-based antiretroviral therapy programs can
overcome barriers to retention of patients and decongest health services in
sub-Saharan Africa: a systematic review. Int Health, 3(3), 169-179. https://academic.oup.com/inthealth/article/5/3/169/651961?login=false.
[20] Ebua, A. F., Shey, N. D., Ngouamkeu, N. E. K.,
& Yannick, N. A. D., 2023, Predictors and Facilitators of High Viral Load
in HIV Positive Persons on Antiretroviral Treatment in the East Region of
Cameroon. https://www.texilajournal.com/thumbs/article/Public_Health_Vol10_Issue3_Article_17.pdf.
[21] Bateganya, M, Amanyeiwe, U, Roxo U, Dong M, Butler
R, Mubiru F., 2015, Impact of support groups for people living with HIV on
clinical outcomes: a systematic review of the literature. J Acquir Immune
Defic Syndr, 68, S368–S374. https://journals.lww.com/jaids/fulltext/2015/04151/Impact_of_Support_Groups_for_People_Living_With.13.aspx.
[22] Daskalopoulou, M., Lampe, F. C., Sherr, L.,
Phillips, A. N., Johnson, M. A., Gilson, R., . & ASTRA Study Group., 2017,
Non-disclosure of HIV status and associations with psychological factors, ART
non-adherence, and viral load non-suppression among people living with HIV in
the UK. AIDS and Behavior, 21, 184-195. https://link.springer.com/article/10.1007/s10461-016-1541-4.
[23] Buma, D., Bakari, M., Fawzi, W., & Mugusi, F.,
2015, The Influence of HIV-Status Disclosure on Adherence, Immunological and
Virological Outcomes among HIV-Infected Patients Started on Antiretroviral
Therapy in Dar-es- Salaam, Tanzania. http://dx.doi. org/10.16966/2380-5536.111.
[24] Mutevedzi, P. C., Lessells, R. J., Rodger, A. J.,
Newell, M. L., & the Africa Centre for Population Health., 2019,
Association of age with mortality and virological and immunological response to
antiretroviral therapy in rural South African adults. PLoS ONE, 14(6),
e0218277. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0021795.
[25] Bangsberg, D. R., Ragland, K., Monk, A., &
Deeks, S. G., 2011, A single tablet regimen is associated with higher adherence
and viral suppression than multiple tablet regimens in HIV+ homeless and
marginally housed people. AIDS, 25(11), 1737-1741. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540404/pdf/nihms252776.pdf.
[26] Sanne, I., Westreich, D., MacPhail, A., Rubel, D.,
Majuba, P., & Rie, A., 2009, Long term outcomes of antiretroviral therapy
in a large HIV/AIDS care clinic in urban South Africa: a prospective cohort
study. Journal of the International AIDS Society, 12, 38 – 38. https://link.springer.com/article/10.1186/1758-2652-12-38.
Elul, B, Lamb, M. R, Lahuerta , M, Abacassamo F, Ahoua, L, Kujawski, S, et al. A combination strategy for enhancing linkage to and retention in HIV care among adults newly diagnosed with HIV in Mozambique. [doi:10.1097/QAD.0000000000000182 https://journals.lww.com/aidsonline/abstract/2014/02200/differential_impact_of_apobec3_driven_mutagenesis.4.aspx