Unsuppressed HIV Viral Load and Related Factors in Patients Receiving Antiretroviral Treatment in Tanganyika Province, Democratic Republic of Congo (DRC)

Abstract

Antiretroviral treatment (ART) has revolutionized the management of the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), enabling long-term viral load (VL) suppression in patients. Despite the proven effectiveness of ART, a significant proportion of patients with HIV receiving ART fail to achieve viral load suppression (VLS). This study aimed to identify factors associated with low VLS in the Tanganyika province. An unmatched case–control study was conducted from January 2022 to June 2023, including 22 care facilities with viral load data. Data were collected from patient records. For each reviewed record, the patient was invited for an interview upon providing informed consent. Data were analyzed using SPSS version 27. In a multivariable binary logistic regression model, variables with a p-value < 0.05 and a 95% confidence interval for the adjusted odds ratio were considered significantly associated with unsuppressed VL. A total of 462 individuals, including 156 cases and 306 controls, were included in the study. The mean age (standard deviation) of participants was 42.12 (±11.6) years. The following covariates were significantly associated with unsuppressed VL: poor HIV status disclosure to a confidant [adjusted OR = 2.10, 95% CI (1.33–3.31), p = 0.001], poor ART adherence [adjusted OR = 2.01, 95% CI (1.25–3.23), p = 0.004], ART interruption [adjusted OR = 3.43, 95% CI (2.00–5.88), p < 0.001], no participation in support groups [adjusted OR = 2.16, 95% CI (1.25–3.71), p = 0.005], baseline WHO clinical stage 3 and 4 [adjusted OR = 2.24, 95% CI (1.32–3.79), p = 0.003], opportunistic infections (OIs) [adjusted OR = 2.30, 95% CI (1.27–4.16), p = 0.006], and non-communicable chronic diseases (NCDs) [adjusted OR = 2.30, 95% CI (1.10–4.79), p = 0.026]. Given the clear association between several factors and unsuppressed VL, prevention should involve the implementation of innovative strategies targeting at-risk patient groups. Strengthening the monitoring of these factors among active patients at each appointment is recommended to achieve this goal.