Determinants of virological suppression among adults living with HIV and linked to care in Wakiso district

Abstract

Besides preventing transmissions, virological suppression has numerous reproductive health implications especially for adults, them being of reproductive age, when not achieved. For female adults, non virological suppression increases risks of maternal morbidity and mortality that arises from obstetric complications and can even cause infertility. Some women living with HIV face multiple challenges with mere conception. The number of ovulatory cycles has been found to correlate with the severity of immunosuppression among women. Some HIV-infected women have been found to have reduced ovarian reserve. For adult males, non virological suppression can also lower sperm quality, and cause infertility. The impairment includes lower ejaculation volume, sperm count, and progressive sperm motility despite normal morphology compared to non-HIV-infected men and an increased sperm nuclear fragmentation rate. Thus, virological non suppression can greatly undermine the reproductive health of adults living with HIV. The reproductive health predicaments mentioned above could be rife, globally given that virological suppression among the adult population is sub optimal. In 2017 less than half of all people living with HIV were virally suppressed. The purpose of this study was to therefore assess the determinants of virological suppression among adults living with HIV and linked to care in Wakiso district – central Uganda Methods: This study adopted an analytical cross sectional survey design to study 196 adults who were living with HIV and linked to care in Wakiso district. Wakiso district was purposively sampled, the health facilities were sampled using stratified and simple random sampling; the patients were sampled using simple random sampling. Data was collected using structured interviews and medical data abstraction, and the data was captured using a structured questionnaire. Data was analyzed using SPSS version 20. Descriptive and inferential statistical tools were used to analyze the data. More than three quarters of the adults living with HIV and linked to care in Wakiso district have achieved viral suppression 81% (158/196). Adults who were Adventists by religion (COR = 2.112, [CI = 1.342 - 6.122]), and those who were employed (COR = 2.252, [CI = 1.079 - 4.700]) were twice as likely to have achieved virological suppression compared to those of other religions and the unemployed respectively Adults who were on a combination of 2NRTI+PI were three times as likely to have achieved virological suppression (AOR = 3.518, [CI = 1.481 - 8.357]) compared to those who were taking 2NRTI+1NNRTI. Adults who had experienced any drug and food interactions with ART were less likely to have achieved virological suppression (COR = .518, CI = .412 - 0.913]) compared to those who had not experienced any food and drug interactions. Adults who had been on ART for less than five years were less likely to have achieved virological suppression (COR = .363, CI = .172 - .764]) compared to those who had been on ART for more than five years. Conclusion: Virological suppression has been achieved by the majority of adults living with HIV and linked to care in Wakiso district. However, being HIV, and in view of the UNAIDS 90- 90-90 goals and the 95-95-95, virological suppression among adult patients in the district is still lacking, although it can be ably augmented with focus on what predicts it. Both patient and clinical characteristics determine virological suppression among those patients, with the latter being more important.