HIV viral load suppression and associated factors among people with mental disorders at Butabika Hospital and Mulago ISS Clinics: A mixed methods study

Abstract

INTRODUCTION In 2017 Uganda adopted the universal test and treat (UTT) guidelines. According to the UTT guidelines, people who test positive for HIV should be immediately initiated on antiretroviral therapy (ART) regardless of their CD4+ cell count. The same guidelines recommend the use of HIV viral load measurement to assess for patients’ response to ART. However, there are concerns that treatment outcomes among patients who have mental disorders remain below national average.

Aim This study sought to determine the proportion of HIV viral load suppression and the associated factors among people living with HIV (PLHIV) who had mental disorders at Butabika Hospital ART Clinic and Mulago ISS Clinic.

Methods This was a parallel convergent mixed methods design among PLHIV who had a mental disorder at Butabika hospital ART clinic and Mulago ISS Clinic. Using a cross sectional study design, a total of 240 participant medical records were reviewed for the quantitative (for demographics, HIV, mental disorder, ART, tuberculosis (TB), viral load related data) component. In addition, purposively selected seven health care providers and twelve clinically stable patients were enrolled for key informant interviews and in-depth interviews respectively in the qualitative component of the study. The qualitative data collected covered socio-cultural factors that influence HIV viral suppression. Quantitative data was entered into Epi-data 4.4.1.0 exported to STATA 14 for analysis using modified poisson accessed through generalised linear models to assess the factors associated with HIV viral suppression. The proportion of viral load suppression was calculated as the number of participants with viral suppression (a viral load < 1000 copies/ml) divided by the total number of patients enrolled. For the qualitative data, the interviews scripts were synthesised using inductive thematic analysis to generate themes from statements relating to socio-cultural factors that were reported by participants.

Results Between 15th November 2021 and 14th January 2022, a total of 240 PLHIV who had a mental disorder were enrolled in the study with mean (SD) age of 38.9 (±11.2). Of these, 161 (67.1%) were female. Overall, 88.8% (95% Cl: 84.0% – 92.2%) had achieved HIV viral suppression. Being a Muslim (PR=1.15, p-value=0.035), being divorced (PR=0.84, p-value=0.037), a baseline CD4 count <200 (PR=0.83, p-value=0.027), and fair (85-94%) ART adherence level (PR=0.68, p value=0.024) were associated with HIV viral suppression. Disclosure of HIV-serostatus was identified to improve HIV viral suppression due to the social support that came along with disclosure. Participants reported to receive social support from their family, spouses and healthcare providers which they said helped them to achieve viral suppression. Stigma and discrimination from the community towards both HIV and mental disorders was pointed out to hinder PLHIV and mental disorders from achieving viral suppression.

Conclusion HIV viral suppression among PLHIV who had a mental disorder was below the UNAIDS 95% target and is also lower than overall VLS at the respective clinics (Mulago –97% & Butabika – 98%). Being a Muslim positively influenced viral suppression while having fair adherence, a baseline CD4<200 and being divorced reduced the chances of being suppressed. Addressing stigma and discrimination against PLHIV with mental disorders will be critical to optimise viral suppression in this population.