Viral load suppression and associated factors among TASO Mulago clients in 2019

Abstract

The Ugandan guidelines recommend that viral load testing should be done 6 months after initiating ART and thereafter annually for people who have achieved viral load suppression. However, people with detectable viral loads undergo targeted intensified adherence support for 6 months followed by confirmatory viral load testing to differentiate poor adherence from treatment failure (Uganda AIDS Commission, 2015). Therefore, this study was carried out to investigate factors associated with viral load suppression among patients on ART in TASO Mulago with the specific objectives to Estimate the proportion of patients with viral load suppression, and identify demographic factors associated with viral load suppression and identify clinical factors associated with viral load suppression. The dependent variable (all results <1000 copies/ml of blood for plasma was to be categorized as suppressed while ≥1000 copies/ml of blood for plasma was categorized as not suppressed). Different models were run; logit, probit and c-log-log link functions were used to separately fit the data. The best model with the lowest AIC was chosen. Results revealed that most of the ART clients (95.56%) had suppressed results of the viral load as compared to the minority (4.44%) of the clients whose results were not suppressed. At multivariate analysis, it was revealed that clients who are older than 30 years are more likely to have a suppressed viral load as compared to those aged 0-9 years. Those 30-39 years are about 6 times more likely to have a viral load that is suppressed and those 50 years and older are over 14 times more likely to have a suppressed. Clients with an initial CD4 count greater than 200 cells per cubic millimetre were twice as likely to have a suppressed viral load as compared to their counterparts. Clients who had good adherence were more than 21 times more likely to have suppressed viral load as compared to those that have poor adherence. Inconclusion, the study's multivariable analysis directly addresses the specific objectives by identifying age, CD4 count, and adherence as influential factors affecting viral load suppression among ART patients at TASO Mulago, consequently two validating and refuting one of the formulated hypotheses.The study therefore recommends the need to monitor suppression by age group to understand different needs and challenges that affect suppression, adolescent clients should be managed based on clinical care such CD4 count and WHO clinical staging since the study revealed that their adherence is poor compared to the old patients, also, Efforts should be made, in the short term, to make the clinic as user-friendly as possible