Predictors of Unsuppressed HIV Viral Load and Low CD4 Count Among ZIMPHIA 2020 Survey Participants

Download Article

DOI: 10.21522/TIJPH.2013.12.04.Art062

Authors : Solomon Mukwenha, Tafadzwa Dzinamarira, Munyaradzi Mapingure, Innocent Chingombe, Rutendo Birri Makota, Elliot Mbunge, Enos Moyo, Garikayi Chemhaka, John Batani, Brian Moyo, Godfrey Musuka

Abstract:

Unsuppressed Viral load and low CD4 counts pose a significant challenge to HIV/AIDS management. Understanding the predictors of unsuppressed viral load and CD4 is critical for developing strategies to mitigate its impact. This study aimed to identify predictors of unsuppressed HIV viral load and low CD4 counts among Zimbabwe population-based HIV impact assessment survey (ZIMPHIA 2020) study participants. We analysed data from the ZIMPHIA 2020 survey. Data collection was done using structured interviews, home-based HIV testing and laboratory testing. Blood samples from participants were tested for HIV and those positive were analysed for CD4 counts and Viral load tests. We then calculated odds ratios for predictors of unsuppressed viral load (viral load ≥1000 copies/mL) and low CD4 counts (CD4< 350). The prevalence of unsuppressed viral load and low CD4 count were 20.7% and 34.7%, respectively. Males were more likely to be virally unsuppressed (25.1%) than females (18.8%) adjusted odds ratio (aOR) (95% confidence interval) 1.74 (1.43-2.11) p-value < 0.001. The odds of having a low CD4 count were higher among males (41%) than females (19%) aOR (95% confidence interval) 3.07 (2.57-3.66). Urban dwellers were more likely to have a low CD4 count (31.1%0 than rural dwellers (23.8%) aOR (95% confidence interval) 1.45 (1.21-1.73) p-value <0.001. The common predictors of both unsuppressed viral load and low CD4 were gender, never tested for HIV and never had a viral load test.

References:

[1].  UNAIDS, 2021, Global AIDS Strategy 2021–2026 End Inequalities. End AIDS. https://www.unaids.org/en/resources/documents/2021/2021-2026-global-AIDS-strategy

[2].  WHO, 2023, New WHO guidance on HIV viral suppression and scientific updates released at IAS 2023, Accessed: May 29, 2024. https://www.who.int/news/item/23-07-2023-new-who-guidance-on-hiv-viral-suppression-and-scientific-updates-released-at-ias-2023

[3].  ICAP, 2021, Zimbabwe Population-based HIV Impact Assessment 2020, Accessed: May 23, 2024. [Online]. Available: http://phia.icap.columbia.edu

[4].  PEPFAR, 2022, Zimbabwe Country Operational Plan (COP) 2022 Strategic Direction Summary (SDS), Accessed: Aug. 03, 2024. [Online]. Available: https://www.state.gov/wp-content/uploads/2022/09/Zimbabwe-COP22-SDS.pdf

[5].  WHO, 2023, THE Role of HIV Viral Suppression in Improving Individual Health and Reducing Transmission Policy Brief., Accessed: Aug. 29, 2024. [Online]. Available: https://iris.who.int/bitstream/handle/10665/360860/9789240055179-eng.pdf?sequence=1

[6].  WHO, 2020, HIV Treatment and Care Team, Accessed: Apr. 23, 2024. [Online]. Available: https://www.who.int/ publications /I/item/point-of-care-test-for-identifying-people-living-with-advanced-HIV-disease

[7].  Ekong, E., Ndembi, N., Okonkwo, P., Dakum, P., Idoko, J., Banigbe, B., Okuma, J., Agaba, P., Blattner, W., Adebamowo, C., & Charurat, M., 2020, Epidemiologic and viral predictors of antiretroviral drug resistance among persons living with HIV in a large treatment program in Nigeria. AIDS Research and Therapy, 17(1), 1–8. https://doi.org/10.1186/S12981-020-0261-Z/TABLES/2

[8].  WHO, 2016, Global Health Sector Strategy on HIV 2016–2021 Towards ending AIDS. Accessed: Aug. 14, 2024.Online]. Available: https://www.who.int/publications/i/item/WHO-HIV-2016.05

[9].  Calmy, A., Ford, N., & Meintjes, G., 2018, The Persistent Challenge of Advanced HIV Disease and AIDS in the Era of Antiretroviral Therapy. Clinical Infectious Diseases, 66(suppl_2), S103-SS105. https://doi.org/10.1093/CID/CIX1138

[10]. Ford, N., Meintjes, G., Vitoria, M., Greene, G., & Chiller, T., 2017, The evolving role of CD4 cell counts in HIV care. Current Opinion in HIV and AIDS, 12(2), 123–128. https://doi.org/10.1097/COH.0000000000000348

[11]. Rice, B., Boulle, A., Schwarcz, S., Shroufi, A., Rutherford, G., & Hargreaves, J., 2019, The Continuing Value of CD4 Cell Count Monitoring for Differential HIV Care and Surveillance. JMIR Public Health and Surveillance, 5(1), e11136. https://doi.org/10.2196/11136

[12]. Andarge, D. E., Hailu, H. E., & Menna, T., 2022, Incidence, survival time and associated factors of virological failure among adult HIV/AIDS patients on first line antiretroviral therapy in St. Paul’s Hospital Millennium Medical College—A retrospective cohort study. PLOS ONE, 17(10), e0275204. https://doi.org/10.1371/JOURNAL.PONE.0275204

[13]. Sithole, Z., Mbizvo, E., Chonzi, P., Mungati, M., Juru, T. P., Shambira, G., Gombe, N. T., & Tshimanga, M., 2018, Virological failure among adolescents on ART, Harare City, 2017- a case-control study. BMC Infectious Diseases, 18(1), 1–8. https://doi.org/10.1186/S12879-018-3372-6/TABLES/5

[14]. Jackson, C., Rehman, A. M., McHugh, G., Gonzalez-Martinez, C., Ngwira, L. G., Bandason, T., Mujuru, H., Odland, J. O., Corbett, E. L., Ferrand, R. A., & Simms, V., 2022, Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis. BMC Pediatrics, 22(1), 1–9. https://doi.org/10.1186/S12887-022-03400-4/TABLES/5

[15]. Hakizayezu, F., Biracyaza, E., Niyompano, H., & Umubyeyi, A., 2022, The Frequency and Predictors of Unsuppressed HIV Viral Load Among People with HIV in Nyaruguru District, Rwanda. HIV/AIDS (Auckland, N.Z.), 14, 381–395. https://doi.org/10.2147/HIV.S376053

[16]. Melku, M., Gesesew, H. A., & Ward, P. R., 2022, Magnitude and predictors of HIV-Drug resistance in Africa: A protocol for systematic review and meta-analysis. PLOS ONE, 17(4), e0267159. https://doi.org/10.1371/JOURNAL.PONE.0267159

[17]. Chikwari, C. D., Kranzer, K., Simms, V., Patel, A., Tembo, M., Mugurungi, O., Sibanda, E., Mufare, O., Ndlovu, L., Muzangwa, J., Vundla, R., Chibaya, A., Hayes, R., Mackworth-Young, C., Bernays, S., Mavodza, C., Hove, F., Bandason, T., Dauya, E., & Ferrand, R. A., 2024, Differentiated care for youth in Zimbabwe: Outcomes across the HIV care cascade. PLOS Global Public Health, 4(2 February). https://doi.org/10.1371/journal.pgph.000255

[18]. Ssemwanga, D., Asio, J., Watera, C., Nannyonjo, M., Nassolo, F., Lunkuse, S., Salazar-Gonzalez, J. F., Salazar, M. G., Sanyu, G., Lutalo, T., Kabuga, U., Ssewanyana, I., Namatovu, F., Namayanja, G., Namale, A., Raizes, E., Kaggwa, M., Namuwenge, N., Kirungi, W., Kaleebu, P., 2020, Prevalence of viral load suppression, predictors of virological failure and patterns of HIV drug resistance after 12 and 48 months on first-line antiretroviral therapy: a national cross-sectional survey in Uganda. Journal of Antimicrobial Chemotherapy, 75(5), 1280. https://doi.org/10.1093/JAC/DKZ561

[19]. Waju, B., Dube, L., Ahmed, M., & Assefa, S. S., 2021, Unsuppressed viral load level in public health facilities: nonvirological predictors among adult antiretroviral therapy users in southwestern ethiopia. HIV/AIDS (Auckland, N.Z.), 13, 513. https://doi.org/10.2147/HIV.S304653

[20]. Mhlanga, T. T., Jacobs, B. K. M., Decroo, T., Govere, E., Bara, H., Chonzi, P., Sithole, N., Apollo, T., Van Damme, W., Rusakaniko, S., Lynen, L., & Makurumidze, R., 2022, Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018. AIDS Research and Therapy, 19(1). https://doi.org/10.1186/s12981-022-00458-z

[21]. Soogun, A. O., Kharsany, A. B. M., Zewotir, T., North, D., Ogunsakin, E., & Rakgoale, P., 2022, Spatiotemporal variation and predictors of unsuppressed viral load among hiv-positive men and women in rural and peri-urban kwazulu-natal, south africa. Tropical Medicine and Infectious Disease, 7(9), 232. https://doi.org/10.3390/TROPICALMED7090232/S1

[22]. ZimStat, 2022, 2022 Population and housing census- preliminary report on population figures, Accessed: Aug. 12, 2024.Online]. Available: https://www.zimstat.co.zw/wp-content/uploads/2022/07/Census 2022_ Preliminary_Report.pdf

[23]. Wisaksana, R., Hartantri, Y., & Hutajulu, E., 2024, Risk Factors Associated with Unsuppressed Viral Load in People Living with HIV Receiving Antiretroviral Treatment in Jawa Barat, Indonesia. HIV/AIDS - Research and Palliative Care, 16, 1–7. https://doi.org/10.2147/HIV.S407681

[24]. Nyaradzo, B., Kudya, N., Mbofana, E., Masaka, S., Garone, D., Chen, C.-Y., Mulingwa, A., Uzande, C., Isaakidis, P., & Ndlovu, Z., 2019, Scaling up HIV viral load monitoring in Manicaland, Zimbabwe: challenges and opportunities from the field. Public Health Action, 9(4), 177–181. https://doi.org/10.5588/PHA.19.0024

[25]. Asfaw, A., Ali, D., Eticha, T., Alemayehu, A., Alemayehu, M., & Kindeya, F., 2015, CD4 Cell Count Trends after Commencement of Antiretroviral Therapy among HIV-Infected Patients in Tigray, Northern Ethiopia: A Retrospective Cross-Sectional Study. PLOS ONE, 10(3), e0122583. https://doi.org/10.1371/JOURNAL.PONE.0122583 doi:10.1371/JOURNAL. PONE.0122583

[26]. Mapiye, M., Ravhuhali, K., de Voux, A., & Kufa, T., 2024, Factors associated with an unsuppressed viral load among HIV-positive individuals attending STI services in South Africa, 2019. BMC Infectious Diseases, 24(1), 1–8. https://doi.org/10.1186/S12879-023-08756-1/TABLES/2

[27]. Gezie, L. D., 2016, Predictors of CD4 count over time among HIV patients-initiated ART in felege hiwot referral hospital, northwest Ethiopia: Multilevel analysis. BMC Research Notes, 9(1), 1–9. https://doi.org/10.1186/S13104-016-2182-4/TABLES/6

[28]. Montarroyos, U. R., Miranda-Filho, D. B., César, C. C., Souza, W. V., Lacerda, H. R., Albuquerque, M. D. F. P. M., Aguiar, M. F., & Ximenes, R. A. D. A., 2014, Factors related to changes in CD4+ T-cell counts over time in patients living with HIV/AIDS: a multilevel analysis. PloS One, 9(2). https://doi.org/10.1371/JOURNAL.PONE.0084276

[29]. Bukenya, D., Mayanja, B. N., Nakamanya, S., Muhumuza, R., & Seeley, J., 2019, What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Research and Therapy, 16(1). https://doi.org/10.1186/S12981-018-0214-Y

[30]. Mantell, J. E., Masvawure, T. B., Mapingure, M., Apollo, T., Gwanzura, C., Block, L., Bennett, E., Preko, P., Musuka, G., & Rabkin, M., 2019, Engaging men in HIV programmes: a qualitative study of male engagement in community-based antiretroviral refill groups in Zimbabwe. Journal of the International AIDS Society, 22(10). https://doi.org/10.1002/JIA2.25403

[31]. Weissman, S., Duffus, W. A., Iyer, M., Chakraborty, H., Samantapudi, A. V., & Albrecht, H., 2015, Rural-urban differences in HIV viral loads and progression to AIDS among new HIV cases. Southern Medical Journal, 108(3), 180–188. https://doi.org/10.14423/SMJ.0000000000000255

[32]. Malaza, A., Mossong, J., Bärnighausen, T., Viljoen, J., & Newell, M. L., 2013, Population-based CD4 counts in a rural area in South Africa with high HIV prevalence and high antiretroviral treatment coverage. Plos One, 8(7), e70126–e70126. https://doi.org/10.1371/JOURNAL.PONE.0070126

[33]. Adoga, M. P., Pennap, G. R., John, P. A., Shawulu, P. T., Kaba, S. V., Forbi, J. C., & Agwale, S. M., 2012, CD4- and CD3-T lymphocyte reference values of immunocompetent urban and rural subjects in an African nation. Scandinavian Journal of Immunology, 76(1), 33–38. https://doi.org/10.1111/J.1365-3083.2012.02700.X

[34]. Ministry of Health and Child Care, Zimbabwe, AIDS & TB Programme for the Prevention, Care and Treatment of HIV in Zimbabwe, 2022, Operational and Service Delivery Manual 2022 Edition. operational and service delivery manual for the prevention, care and treatment of hiv in zimbabwe operational and service delivery manual 1 content abbreviations 2 background and rationale for the manual 3.

[35]. Owusu, L. B., Ababio, C., Boahene, S., Zakaria, A. F. S., Emikpe, A. O., Dwumfour, C. K., Appiagyei, K. A., & Apiribu, F., 2023, The predictors of unsuppressed viremia among PLHIV: a cross-sectional study in Ghana. BMC Public Health, 23(1). https://doi.org/10.1186/S12889-023-16032-9

[36]. Atuhaire, P., Hanley, S., Yende-Zuma, N., Aizire, J., Stranix-Chibanda, L., Makanani, B., Milala, B., Cassim, H., Taha, T., & Fowler, M. G., 2019, Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis. PLoS ONE, 14(10). https://doi.org/10.1371/JOURNAL.PONE.0219415

[37]. Tomita, A., Vandormael, A., Bärnighausen, T., Phillips, A., Pillay, D., De Oliveira, T., Tanser, F., & South, A., 2019, Sociobehavioral and community predictors of unsuppressed HIV viral load: multilevel results from a hyperendemic rural South African population HHS Public Access. AIDS, 33(3), 559–569. https://doi.org/10.1097/QAD. 00000 000 000 02100

[38]. Hicham, T., Ilyas, E., Tarik, H., Noureddine, B., Omar, B., Rachid, F., Naoufal, H., & Mohammed, B., 2019, Risk factors associated with unsuppressed viral load in HIV-1 infected patients at the first antiretroviral therapy in Morocco. International Journal of Mycobacteriology, 8(2), 113–117. https://doi.org/10.4103/IJMY.IJMY_41_19

[39]. Myers, B., Lombard, C., Joska, J. A., Abdullah, F., Naledi, T., Lund, C., Petersen Williams, P., Stein, D. J., & Sorsdahl, K. R., 2021, Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa. AIDS and Behavior, 25(11), 3758–3769. https://doi.org/10.1007/S10461-021-03263-3

[40]. Malbergier, A., Do Amaral, R. A., & Cardoso, L. D., 2015, Alcohol dependence and CD4 cell count: is there a relationship? AIDS Care, 27(1), 54–58. https://doi.org/10.1080/09540 121.2014.947235

[41]. Lesko, C. R., Nance, R. M., Lau, B., Fojo, A. T., Hutton, H. E., Delaney, J. A. C., Crane, H. M., Cropsey, K. L., Mayer, K. H., Napravnik, S., Geng, E., Mathews, W. C., McCaul, M. E., & Chander, G., 2021, Changing Patterns of Alcohol Use and Probability of Unsuppressed Viral Load Among Treated Patients with HIV Engaged in Routine Care in the United States. AIDS and Behaviour.