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Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018
BACKGROUND: Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9270749/ https://www.ncbi.nlm.nih.gov/pubmed/35810317 http://dx.doi.org/10.1186/s12981-022-00458-z |
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author | Mhlanga, Trudy Tholakele Jacobs, Bart K. M. Decroo, Tom Govere, Emma Bara, Hilda Chonzi, Prosper Sithole, Ngwarai Apollo, Tsitsi Van Damme, Wim Rusakaniko, Simbarashe Lynen, Lutgarde Makurumidze, Richard |
author_facet | Mhlanga, Trudy Tholakele Jacobs, Bart K. M. Decroo, Tom Govere, Emma Bara, Hilda Chonzi, Prosper Sithole, Ngwarai Apollo, Tsitsi Van Damme, Wim Rusakaniko, Simbarashe Lynen, Lutgarde Makurumidze, Richard |
author_sort | Mhlanga, Trudy Tholakele |
collection | PubMed |
description | BACKGROUND: Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. METHODS: We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. RESULTS: We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country’s ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14–1.24]) and adolescents (10–19 years) (vs adults (25–49 years), aOR = 3.11, [95% CI 2.9–3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17–1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44–1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014–2015 (vs < 2010, aOR = 0.83, [95% CI 0.79–0.88]) and from 2016 onwards (vs < 2010, aOR = 0.84, [95% CI 0.79–0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (20–24 years) (vs adults (25–49 years), (aOR) = 3.48, [95% CI 2.16 -5.83]), adolescents (10–19 years) (vs adults (25–49 years), aOR = 2.76, [95% CI 2.11–3.72]) and children (0–9 years) (vs adults (25–49 years), aOR = 1.51, [95% CI 1.03–2.22]) were at risk of VL non-suppression. CONCLUSION: Close to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12981-022-00458-z. |
format | Online Article Text |
id | pubmed-9270749 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-92707492022-07-10 Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 Mhlanga, Trudy Tholakele Jacobs, Bart K. M. Decroo, Tom Govere, Emma Bara, Hilda Chonzi, Prosper Sithole, Ngwarai Apollo, Tsitsi Van Damme, Wim Rusakaniko, Simbarashe Lynen, Lutgarde Makurumidze, Richard AIDS Res Ther Research BACKGROUND: Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. METHODS: We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. RESULTS: We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country’s ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14–1.24]) and adolescents (10–19 years) (vs adults (25–49 years), aOR = 3.11, [95% CI 2.9–3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17–1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44–1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014–2015 (vs < 2010, aOR = 0.83, [95% CI 0.79–0.88]) and from 2016 onwards (vs < 2010, aOR = 0.84, [95% CI 0.79–0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (20–24 years) (vs adults (25–49 years), (aOR) = 3.48, [95% CI 2.16 -5.83]), adolescents (10–19 years) (vs adults (25–49 years), aOR = 2.76, [95% CI 2.11–3.72]) and children (0–9 years) (vs adults (25–49 years), aOR = 1.51, [95% CI 1.03–2.22]) were at risk of VL non-suppression. CONCLUSION: Close to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12981-022-00458-z. BioMed Central 2022-07-09 /pmc/articles/PMC9270749/ /pubmed/35810317 http://dx.doi.org/10.1186/s12981-022-00458-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Mhlanga, Trudy Tholakele Jacobs, Bart K. M. Decroo, Tom Govere, Emma Bara, Hilda Chonzi, Prosper Sithole, Ngwarai Apollo, Tsitsi Van Damme, Wim Rusakaniko, Simbarashe Lynen, Lutgarde Makurumidze, Richard Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
title | Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
title_full | Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
title_fullStr | Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
title_full_unstemmed | Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
title_short | Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
title_sort | virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018 |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9270749/ https://www.ncbi.nlm.nih.gov/pubmed/35810317 http://dx.doi.org/10.1186/s12981-022-00458-z |
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