Burden of and factors associated with virological failure among HIV positive patients on antiretroviral therapy (ART) in Nsanje district, Malawi
Loading...
Date
2021-08-18
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kamuzu University of Health Sciences
Abstract
In efforts to fight HIV, many countries including Malawi started implementation of universal ART
eligibility for all HIV infected individuals as a strategy for reaching the 90-90-90 targets. This led
to the increase in ART coverage hence intensifying the need for scale-up of ART monitoring, for
which the current gold standard is Viral Load (VL) testing. Despite the increasing access to ART
and VL monitoring, numerous studies have demonstrated suboptimal levels of viral suppression
(VS) in different populations in many low-resource settings. Therefore, this research will help to
determine the burden of virological failure and focus on factors leading to virological failure which
will in turn lead to better targeting strategies and policy change.
The main objective of the study was to determine the burden of virological failure and factors
associated with virological failure among HIV patients on ART in Nsanje district.
This was a cross sectional quantitative study using Laboratory information system database, ART
master cards and registers. The study targeted HIV positive patients on ART for > 6 months from
July 2015 to June 2019 in 14 facilities in Nsanje district. The criteria for the study was a VL result
within the stated period. Data was analyzed using STATA version 16.
451 participants were enrolled in this study. 267(59.2%) participants were married, and 278
(61.6%) started ART due to WHO clinical stage. Of the 451 study participants, 321(71.2%) failed
to achieve viral suppression (VL=<1000 copies). In univariate analysis, age at ART initiation,
occupation (OR 0.203, 95% CI 0.11, 0.39; p<0.003), marital status, duration on ART (OR 0.55,
95% CI 0.33, 0.92; p=0.023) and ART adherence (OR 5.125, 95% CI 3.01, 8.74; p<0.0001) were
associated with VF. Age and Fair/poor adherence (AOR 4.221, 95% CI 2.41, 7.38; p<0.0001) was
statistically significant in multivariate analysis.
Age, ART adherence, marital status, occupation and duration on ART were identified as some of
the factors associated with VF. Proper strategies should be developed in order to reduce VF and
improve adherence.