Factors associated with virological non-suppression among HIV-positive patients on Antiretroviral Therapy in Uganda, Komamboga Health Centre, Kawempe Division

Abstract

Introduction The United Nations program on HIV/AIDS (UNAIDS) 2020 A third goal targets to have 90% of all clients on Antiretroviral therapy (ART) virally suppressed by 2020. Uganda is below this target by 10%. The urban and peri-urban populations are even further below this target by an estimated 30 %( UPHIA, 2017) We therefore conducted a study to determine factors that are associated with virological non-suppression among clients on ART at Komamboga health centre, Kawempe division. Methods This was a cross-sectional study that utilised qualitative and quantitative approaches. The study population were clients enrolled into the ART clinic at Komamboga Health centre. Quantitative data was collected using a semi-structured questionnaire and review of clinical notes. It was supplemented with qualitative data which was collected using Key informant interviews (KII) and focus group discussions (FGDs)For quantitative data analysis, a descriptive analysis and a multivariable modified Poisson regression model was done using the STATA version 12. Qualitative data analysis was manually done by thematic analysis. Results: A total of 347 respondents participated in this study. The proportion of non-suppression was 38.9%. At multivariate modified Poisson analysis, the factors found to be independently associated with virological non-suppression were; poor adherence to treatment(aPRR=2.364;95%CI:1.487-3.760),non-disclosure to partners (aPRR=1.815;95%CI:1.259-2.617, p=0.001), smoking (aPRR=0.534;95%CI:0.308-0.926, p=0.025), baseline CD4 count between201 to 500 cells/mm3, and above 500cells/mm3 were lower at (aPRR=0.577; 95%CI: 0.380-0.875, p=0.010) and (aPRR=0.551; 95%CI: 0.333-0.911, p=0.020). In the qualitative inquiry, five thematic areas emerged that is, non-adherence to drugs, stigma and disclosure, myths and misconceptions in the community, drug stock outs and provision of care. Conclusion In this study, we found that non-adherence to treatment, smoking, multiple sexual partners, low baseline CD4 count were significantly associated with non-suppression. Most of these factors are largely lifestyles which are driven by broader cultural and societal constructs. Programs and policies focused on improving eliminating HIV should consider broadening their influence on these issues through multi-sectoral approaches.