ADHERENCE TO THE MANAGEMENT GUIDELINES FOR PATIENTS WITH HIGH HIV VIRAL LOADS IN KIBOGA AND KYANKWANZI DISTRICTS

Abstract

This was a retrospective cohort mixed methods study of HIV patients who had at least one high viral load from a sample taken between 1st April 2016 and 30th March 2017 while attending any health facility in Kiboga and Kyankwanzi districts. Information regarding intensive adherence counselling, repeat viral load testing and ART switching was extracted from patients’ records using a pre-designed extraction tool between 27th December 2017 and 25th January 2018. Data was entered in Epi-DATA and analysed using STATA version 14. Poisson regression was used to assess the association between viral suppression and the number of counselling sessions attended. Qualitative data were collected through in-depth interviews and analysed manually by themes. Results: Forty-five of the 564 patients enrolled in the study were lost to follow up and only 519 patients were included in analysis. Only 40.8% (212/519) received all the three counselling sessions and 11.3% (23/202) of those that had virologic failure were switched to the second-line ART regimen. Suppression following a repeat viral load was not associated with the number of counselling sessions attended (Adjusted IRR 0.79(CI=0.76-1.21) for 1or2 sessions and adjusted IRR 0.93 (CI=0.79-1.23) for 3counselling sessions when compared with no counselling session at all). Overall adherence to the guideline was attained in only 5% (21/417) of the patients that had the first counselling session. ART stock-outs, lack of confidence in the second-high viral load as an accurate measure of virologic failure, challenges in convening the switch committee, lack of counselling space, poor documentation and long waiting hours were the most common health system barriers to adherence to the guideline. Stigma, lack of transport, not being empowered to demand, representation, and fear of the second-line regimen were some of the patient-related barriers to adherence to the management guideline for patients with high viral loads. Conclusion Adherence to viral load management guideline for patients with high viral loads was very low in Kiboga and Kyankwanzi districts. Viral load suppression was not associated with the number of intensive adherence counselling sessions attended. Recommendations Given that there was no variation in suppression by the number of counselling sessions attended, the quality of counselling needs to be assessed. Training of health workers and patients is required to improve adherence to this guideline.