Factors associated with virological non-suppression among HIV positive adult males (15 years or older) in the fishing communities of Bulisa district.
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Background: Virological non-suppression is a key driver of HIV transmission. However, the prevalence and determinants of virological non-suppression in fishing communities are not well understood. This study was set out to determine the prevalence and determinants of virological nonsuppression among HIV positive males (15 years or older) in the fishing communities of Bulisa district. Methods: A cross-sectional study at six health care facilities serving HIV positive patients resident in the fishing communities of Bulisa district was conducted. All HIV positive adult males in care for at least 6 months were included. Primary data from face-face interviews and secondary data from patients’ files were compiled using structured tools. Individual and health facility characteristics associated with virological non-suppression from previous studies were the predictor variables. At multivariable analysis, modified Poisson was used. Modelling was done using a generalised linear model approach with a family of Poisson, a log link and robust standard error accounting for clustering at the health facility level using Stata version 14.0. Ethical approval from the higher degrees, research, and ethics committee of Makerere University- school public health was sought. Permission from the Bulisa district office and consent or assent from participants was also sought. Results: 413 participants with an up to date viral load result were studied of whom 379 were interviewed. All participants with a viral load test were used in the computation of the prevalence. The mean (SD) age was 40(10.7) years. The median (IQR) duration on ART was 37(17-57) months. The majority of participants (70.5%) were engaged in the fishing business. The overall prevalence of virological non-suppression among adult males was 21.3% (95% CI, 18% -26%). At multivariable analysis, hazardous use of alcohol (APR= 1.3, 95%CI =1.1-1.78); moving between landing sites for more than two times a year (APR = 1.54, 95%CI = 1.1-2.1) compared to being stationed at one landing site, experiencing disruptive effects of ARVs towards work (APR = 2.18, 95%CI = 1.29-3.71); missing ARVs (APR = 1.52, 95%CI = 1.09-2.11); being on second or third-line ART (APR = 4.25, 95%CI =3.0-6.0); getting treatment from a high-level health facility that is Bulisa Hospital (APR =1.7, 95%CI =1.49-1.97 ) compared to a lower level health facility; being scheduled to have short clinical appointment intervals (APR = 1.5, 95%CI =1.12-2.25); experiencing some confidentiality (APR =1.38, 95%CI =1.06-1.81) and maximum confidentiality (APR = 1.92, 95%CI =1.5-2.46 ) while at a health facility were associated with a higher likelihood of having virological non suppression. However, having daily average income between UGX 10,000 and 20,000 (APR =0.54, 95%CI =0.46- 0.64) compared to earning less than UGX 10,000; belonging to a treatment group (APR =0.54 , 95%CI =0.41-0.71); being divorced (APR =0.59 , 95%CI =0.39-0.88 ); married (APR =0.59 , 95%CI =0.44-0.80) and cohabiting (APR =0.58, 95%CI = 0.42-0.79) compared to being single and attending health education sessions (APR =0.42 , 95%CI =0.27-0.65) were associated with a lower likelihood of virological non-suppression. Conclusion: The prevalence of virological non-suppression amongst adult males in Bulisa District is more than twice as high compared to virological non-suppression among adult males in Uganda of 9.7% and UNAIDs non-suppression threshold of utmost 5%. Mobility between landing sites, hazardous use of alcohol, length of clinical appointments, level of HIV treatment health facility, and being a member of a treatment support group influence virological non suppression. Establishing ART refills points at fishing sites, initiating alcohol withdrawal programs at community level, enrolling patients into treatment support groups, and building the capacity of health workers in the management of HIV positive patients is be pivotal in the attainment of the UNAIDS virological suppression threshold of 95% by the year 2030.