Factors associated with unsuppressed viral load among HIV-positive patients on Anti-retroviral therapy, Gihundwe Hospital, Rusizi District, Rwanda, 2016-2017

  • Viral hepatitis and HIV
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Background: HIV remains a major public health challenge in Rwanda, with an estimated national prevalence of 3% among adults aged 15-49 years (4% in men and 2% in women). As the country strives to achieve HIV epidemic control by enrolling more HIV-positive patients into anti-retroviral therapy (ART), monitoring viral suppression and identifying determinants of treatment failure is important to inform timely interventions. We estimated the proportion of virologically non-suppressed patients, and identified the factors associated with non-suppression among patients on ART at Gihundwe hospital, Rusizi district among HIV-positive (HIV+) individuals enrolled in HIV Program.
Methods: We conducted a cross-sectional study by abstracting clinical data from a randomly selected sample of 384 patients on ART during the period, July 2016 to September 2017. We defined virological non-suppression as having >20 copies of viral Ribonucleic acid (RNA)/ml at least six months after ART initiation. We obtained data on socio-demographic, clinical, psychological and behavioral characteristics from patients’ clinical files. We used logistic regression to identify factors independently associated with virological non-suppression.
Results: Of the 384 patients, 215 (56%) were females while the median age was 44 years (5-73 years). Eighty-nine (23%) patients were virally non-suppressed. After multivariate analysis, poor adherence (Adjusted Odds Ratio {aOR}=91.0, 95% Confidence Interval {CI}=35.4.-234.2), age group 15-24 years compared to >25 years (aOR=15.5, 95% CI=2.9-82.7), age group 5-14 years compared to >25 years (aOR=9.7, 95% CI=1.1-90.0) and depression (aOR=25.3, 95% CI=4.5-141.8) were independently associated with non-virologic suppression.
Conclusions: We identified poor adherence, depression and young age as predictors of virologic failure among HIV-positive patients on ART at Gihundwe hospital. We recommended intensified adherence counselling, psychosocial and mental health support especially for young HIV-positive clients on ART

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