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Lack of effectiveness of adherence counselling in reversing virological failure among patients on long‐term antiretroviral therapy in rural Uganda
Author(s) -
Birungi J,
Cui Z,
Okoboi S,
Kapaata A,
Munderi P,
Mukajjanga C,
Nanfuka M,
Nyonyintono MS,
Kim J,
Zhu J,
Kaleebu P,
Moore DM
Publication year - 2020
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12790
Subject(s) - medicine , interquartile range , viral load , asymptomatic , antiretroviral therapy , christian ministry , human immunodeficiency virus (hiv) , immunology , theology , philosophy
Objectives The current World Health Organization and Uganda Ministry of Health HIV treatment guidelines recommend that asymptomatic patients who have a viral load ( VL ) ≥ 1000 HIV‐1 RNA copies/ mL should receive adherence counselling and repeat VL testing before switching to second‐line therapy. We evaluated the effectiveness of this strategy in a large HIV treatment programme of The AIDS Support Organisation Jinja in Jinja, Uganda. Methods We measured the HIV VL at enrolment, and for participants with VL ≥ 1000 copies/ mL we informed them of their result, offered enhanced adherence counselling and repeated the VL measurement after 3 months. All blood samples with VL ≥ 1000 copies/ mL were sequenced in the polymerase (pol) region, a 1257‐bp fragment spanning the protease and reverse transcriptase genes. Results One thousand and ninety‐one participants were enrolled in the study; 74.7% were female and the median age was 44 years [interquartile range ( IQR ) 39–50 years]. The median time on antiretroviral therapy (ART) at enrolment was 6.75 years (IQR 5.3–7.6 years) and the median CD 4 cell count was 494 cells/μL ( IQR 351–691 cells/μL). A total of 113 participants (10.4%) had VL s ≥ 1000 copies/ mL and were informed of the VL result and its implications and given adherence counselling. Of these 113 participants, 102 completed 3 months of follow‐up and 93 (91%) still had VL s ≥ 1000 copies/ mL . We successfully genotyped HIV for 105 patients (93%) and found that 103 (98%) had at least one mutation: eight (7.6%) had only one mutation, 94 (89.5%) had two mutations and one sample (1%) had three mutations. Conclusions In this study, enhanced adherence counselling was not effective in reversing virologically defined treatment failure for patients on long‐term ART who had not previously had a VL test.