Durability of HIV viral suppression and associated factors among adults living with HIV initiated on antiretroviral therapy in Tanzania: a retrospective cohort study

Abstract

Abstract Background: HIV infection remains a global public health issue. As of 2017, there were an estimated 36.9million people living with HIV (PLHIV) and 0.9 million deaths were reported due to HIV-related causes. The scale up of antiretroviral therapy (ART) for PLHIV has decrease HIV incidence and averted significant number of deaths over the last decade. To accelerate the efforts in HIV control and end the HIV epidemic by 2030, the Joint United Nations programme on HIV/AIDS (UNAIDS) recommended the 95-95-95 targets. Viral suppression is the ultimate clinical biomarker for healthy outcomes and HIV transmission. Sustaining Viral Suppression is desirable in the prevention of HIV transmission and thus achieving the third ‘95’ target. Reports show PLHIV on ART has achieved viral suppression, but the durability of viral suppression is not known.This study aimed to determine the durability of viral suppression and its associated factors among adults living with HIV initiated on ART in Tanzania mainland between 2018 and 2019. Methodology: We conducted a retrospective cohort study from routinely collected data among PLHIV attending care and treatment clinics in mainland Tanzania. Adults living with HIV who were initiated on ART from 2018 to 2019 were recruited and followed for two years. Sociodemographic and clinical characteristics such as age, sex, HIV stages, and CD4 count were collected. A cleaned dataset was analyzed by using STATA version 15.0. Numerical and categorical variables were summarized using descriptive statistics. A multilevel mixed effects generalized linear model was used to account for health facility random effects to determine factors associated with durability of Viral suppression at <50 copies/ml. Results: In total, 109,590 PLHIV were included in the study. The mean (±SD) age was 37.5 (± 11.6) years. Seventy-four thousand (68.3%) were females, of which 5,252 (7.0%) were pregnant. About half 50,274 (46.9%) had HIV WHO clinical stage I. The proportion of durable viral suppression was 84.2% (95% CI: 84.0-84.4). Factors associated with durability of viral suppression were female gender (aRR: 1.07; 95% CI: 1.05-1.09), married or cohabiting (aRR: 1.03; 95% CI: 1.02-1.04), HIV stage I (aRR: 1.03; 95% CI: 1.01-1.06), those in multi months dispensing (aRR: 1.14; 95% CI: 1.12-1.15), and being in lake zone (aRR: 1.09; 95% CI: 1.05-1.13). Body mass index (BMI) and CD4 cell count were not significant. Conclusion: Overall, durable suppression was high among PLHIV in Tanzania's mainland. The durable suppression was associated with Sex, marital status, and HIV stage I. Viral load should be monitored longitudinally to determine any treatment failure.