Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland.
INTRODUCTION:This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland. METHODS:This descriptive study used laboratory data from 7/5/2012 to 30/9/2013, whic...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2015-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0116144 |
| _version_ | 1818584240766320640 |
|---|---|
| author | Kiran Jobanputra Lucy Anne Parker Charles Azih Velephi Okello Gugu Maphalala Bernard Kershberger Mohammed Khogali Johnny Lujan Annick Antierens Roger Teck Tom Ellman Rose Kosgei Tony Reid |
| author_facet | Kiran Jobanputra Lucy Anne Parker Charles Azih Velephi Okello Gugu Maphalala Bernard Kershberger Mohammed Khogali Johnny Lujan Annick Antierens Roger Teck Tom Ellman Rose Kosgei Tony Reid |
| author_sort | Kiran Jobanputra |
| collection | DOAJ |
| description | INTRODUCTION:This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland. METHODS:This descriptive study used laboratory data from 7/5/2012 to 30/9/2013, which were linked with the national ART database to provide information on time on ART and CD4 count; information on enhanced adherence counselling was obtained from file review in health facilities. Multivariable logistic regression was used to explore the relationship between viral load, gender, age, time on ART, CD4 count and receiving (or not receiving) enhanced adherence counselling. RESULTS:From 12,063 patients undergoing routine viral load monitoring, 1941 (16%) had detectable viral loads. Children were more likely to have detectable viral loads (AOR 2.6, 95%CI 1.5-4.5), as were adolescents (AOR 3.2, 95%CI 2.2-4.8), patients with last CD4<350 cells/µl (AOR 2.2, 95%CI 1.7-2.9) or WHO Stage 3/4 disease (AOR 1.3, 95%CI 1.1-1.6), and patients on ART for longer (AOR 1.1, 95%CI 1.1-1.2). At retesting, 450 (54% of those tested) showed viral re-suppression. Children were less likely to re-suppress (AOR 0.2, 95%CI 0.1-0.7), as were adolescents (AOR 0.3, 95%CI 0.2-0.8), those with initial viral load> 1000 copies/ml (AOR 0.3, 95%CI 0.1-0.7), and those with last CD4<350 cells/µl (AOR 0.4, 95%CI 0.2-0.7). Receiving (or not receiving) enhanced adherence counselling was not associated with likelihood of re-suppression. CONCLUSIONS:Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads. |
| first_indexed | 2024-12-16T08:18:02Z |
| format | Article |
| id | doaj.art-9952a840af6d4530b11a5eaa173ffe1d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-16T08:18:02Z |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-9952a840af6d4530b11a5eaa173ffe1d2022-12-21T22:38:11ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01102e011614410.1371/journal.pone.0116144Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland.Kiran JobanputraLucy Anne ParkerCharles AzihVelephi OkelloGugu MaphalalaBernard KershbergerMohammed KhogaliJohnny LujanAnnick AntierensRoger TeckTom EllmanRose KosgeiTony ReidINTRODUCTION:This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland. METHODS:This descriptive study used laboratory data from 7/5/2012 to 30/9/2013, which were linked with the national ART database to provide information on time on ART and CD4 count; information on enhanced adherence counselling was obtained from file review in health facilities. Multivariable logistic regression was used to explore the relationship between viral load, gender, age, time on ART, CD4 count and receiving (or not receiving) enhanced adherence counselling. RESULTS:From 12,063 patients undergoing routine viral load monitoring, 1941 (16%) had detectable viral loads. Children were more likely to have detectable viral loads (AOR 2.6, 95%CI 1.5-4.5), as were adolescents (AOR 3.2, 95%CI 2.2-4.8), patients with last CD4<350 cells/µl (AOR 2.2, 95%CI 1.7-2.9) or WHO Stage 3/4 disease (AOR 1.3, 95%CI 1.1-1.6), and patients on ART for longer (AOR 1.1, 95%CI 1.1-1.2). At retesting, 450 (54% of those tested) showed viral re-suppression. Children were less likely to re-suppress (AOR 0.2, 95%CI 0.1-0.7), as were adolescents (AOR 0.3, 95%CI 0.2-0.8), those with initial viral load> 1000 copies/ml (AOR 0.3, 95%CI 0.1-0.7), and those with last CD4<350 cells/µl (AOR 0.4, 95%CI 0.2-0.7). Receiving (or not receiving) enhanced adherence counselling was not associated with likelihood of re-suppression. CONCLUSIONS:Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.https://doi.org/10.1371/journal.pone.0116144 |
| spellingShingle | Kiran Jobanputra Lucy Anne Parker Charles Azih Velephi Okello Gugu Maphalala Bernard Kershberger Mohammed Khogali Johnny Lujan Annick Antierens Roger Teck Tom Ellman Rose Kosgei Tony Reid Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS ONE |
| title | Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. |
| title_full | Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. |
| title_fullStr | Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. |
| title_full_unstemmed | Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. |
| title_short | Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. |
| title_sort | factors associated with virological failure and suppression after enhanced adherence counselling in children adolescents and adults on antiretroviral therapy for hiv in swaziland |
| url | https://doi.org/10.1371/journal.pone.0116144 |
| work_keys_str_mv | AT kiranjobanputra factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT lucyanneparker factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT charlesazih factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT velephiokello factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT gugumaphalala factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT bernardkershberger factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT mohammedkhogali factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT johnnylujan factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT annickantierens factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT rogerteck factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT tomellman factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT rosekosgei factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland AT tonyreid factorsassociatedwithvirologicalfailureandsuppressionafterenhancedadherencecounsellinginchildrenadolescentsandadultsonantiretroviraltherapyforhivinswaziland |