Burden of and factors associated with virological failure among HIV positive patients on antiretroviral therapy (ART) in Nsanje district, Malawi

Burden of and factors associated with virological failure among HIV positive patients on antiretroviral therapy (ART) in Nsanje district, Malawi

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 w...

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Bibliographic Details
Main Author: Mphande, Shupe
Format: Thesis
Language:English
Published: Kamuzu University of Health Sciences 2022
Online Access:http://nkhokwe.kuhes.ac.mw/handle/20.500.12845/627
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Summary: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.

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