Determinants of Undetectable Viral Load among Recipients of HIV Care in Cross River State, Nigeria: A Mixed-Methods Study
Abstract:
Achieving
and sustaining viral load suppression among people living with HIV is essential
for improving treatment outcomes and reducing transmission. However,
determinants of undetectable viral load remain insufficiently documented in
Cross River State, Nigeria, particularly using mixed methods approaches. This
study examined socio-demographic and patient-related determinants of
undetectable viral load among recipients of HIV care in selected health
facilities. A mixed-methods design combined a facility-based cross-sectional
survey with qualitative interviews. Quantitative data were collected from 203
HIV-positive clients aged ≥15 years who had been on antiretroviral therapy
(ART) for at least six months, while qualitative data were obtained from
in-depth interviews with 12 healthcare providers. Descriptive statistics,
Chi-square tests, and multivariate logistic regression were used for
quantitative analysis, and qualitative data were analyzed thematically.
Findings showed that 51.7% of participants achieved undetectable viral load
(<50 copies/mL), 27.6% had suppressed viral load (51–999 copies/mL), and
79.3% attained overall viral suppression. ART adherence emerged as the
strongest predictor of viral suppression, alongside regular clinic attendance,
counselling participation, and use of medication reminders. Conversely, missed
doses, treatment interruptions, recreational drug use, and difficulty accessing
healthcare significantly reduced the likelihood of viral suppression.
Qualitative findings highlighted stigma, economic hardship, transportation
barriers, and occasional drug stock-outs as key contextual factors influencing
adherence. The study underscores the need for patient-centered interventions
that strengthen adherence counselling, improve access to ART, and address
structural and socio-economic barriers to optimize viral suppression outcomes
in resource-limited settings.
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