Abstract:
OBJECTIVES : Identify factors (demographic and clinical)
associated with a non-suppressed
viral load (VL) of people
living with HIV (PLHIV) on antiretroviral therapy (ART) in
Nigeria.
DESIGN : Cross-sectional
study.
SETTING : Sixteen US Agency for International Development
supported states in Nigeria.
PARTICIPANTS : 585 632 PLHIV on ART.
PRIMARY OUTCOME MEASURES : VL non-suppression
(defined as having a VL of at least 1000 HIV RNA copies
per mL of plasma). χ2 testing and multivariable modified
Poisson regression with robust variance estimates were
conducted on routinely collected ART programme data.
RESULTS : Sixty-six
per cent of the study population were
females. The largest age groups were 25–34 and 35–44,
accounting for 32.1% and 31.1%, respectively. Males had a
9% greater likelihood (adjusted prevalence ratio, APR=1.09) of
being non-suppressed.
The age groups below 60+ (APR=0.67)
had a higher likelihood of a non-suppressed
VL, with the
highest in the 0–14 age group (APR=2.38). Clients enrolled
at tertiary and secondary level facilities had the greatest
likelihood of a non-suppressed
VL. Clients who started ART
between 2010 and 2015 had the greatest likelihood of viral
non-suppression
(APR=6.19). A shorter time on ART (<1 year
(APR=3.92)) was associated with a higher likelihood of a non-suppressed
VL. Clients receiving care at private facilities had a
lower likelihood of viral non-suppression
in the adjusted model.
Clients in the Edo (APR=2.66) and Niger (APR=2.54) states had
the greatest likelihood of viral non-suppression.
CONCLUSIONS : Targeting males, clients of younger age, those
on treatment for less than 3 years, clients at tertiary and secondary health facilities, small and medium facilities, and
clients in the Edo, Niger and Borno states for interventions
could lead to improvements in VL suppression in Nigeria. The
independent factors associated with a non-suppressed
VL can
guide improvements in ART programme development and VL
suppression of PLHIV on ART in Nigeria.
Description:
DATA AVAILABILITY STATEMENT : Data are available on reasonable request. The data
that support the findings of this study are owned by the Government of Nigeria and
were used under license for the current study. Access to these data is subject to
restrictions owing to privacy and ethics policies set by the Government of Nigeria
so are not publicly available.
