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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.

Lack of effectiveness of adherence counselling in reversing virological failure among patients on long‐term antiretroviral therapy in rural Uganda