Viral Load Suppression Among HIV Infected Adults On Antiretroviral Treatment In Rural Settings Of The Centre Region Of Cameroon: A Retrospective Cohort Study

Download Article

DOI: 10.21522/TIJPH.2013.12.01.Art027

Authors : Yokyu Zachary Pangwoh, Ndumiso Tshuma, Athanasius Fang Ebua, Ewane Etah Junior, Ndundat Ahmed Chafa, Touo Malanpa Florentine, Onana Akoa Anicet, Nashipu Thalut, Amos Wung-Buh, Jean Ndibi Abanda, Ndimumeh Jerimiah Mbogwe

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