The progress towards achieving the UNAIDS ambitious viral suppression target among adults living with HIV in South-Western Nigeria

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  •   Saheed Opeyemi Usman

  •   Adetosoye Adebanjo

  •   Anuri Emeh

  •   Ererosanaga Ogboghodo

  •   Babatunde Akinbinu

  •   Chisom Udechukwu

  •   Jennifer Ale

  •   Chiedozi Akueshi

  •   Emmanuel Fatunsi

  •   Abimbola Ariyo

  •   Adijat Suraju

  •   Ekene Anugha

  •   Patrick Akande

  •   Femi Owolagba

  •   Toyin Jolayemi

  •   Prosper Okonkwo

Abstract

Background: In sub-Saharan Africa where genotypic drug resistance testing is rarely performed and poor adherence is blamed for the inability to achieve viral suppression and treatment failure, programmatic approaches to preventing & handling these are thus essential. Hypothesis tested was antiretroviral therapy adherence effect on viral load outcome. This study was aimed at determining and monitoring HIV/AIDS disease progression using viral load to provide prognostic information and evaluate patients for viral suppression using the World Health Organization (WHO) guideline strategies.


Methods: This study was an observational study of subjects living with HIV already initiated on antiretroviral therapy for at least six months, enrolled in health facilities across Ondo State, South-Western Nigeria, during a 12-month observation period starting October 2018 till September 2019. Quantitative viral load analysis was done using Polymerase Chain Reaction, Roche Cobas Taqman 96 Analyzer. All data were statistically analyzed, using Statistical Package for the Social Sciences (SPSS), with multiple comparisons done using Post Hoc Bonferonni test. Results: A total of 8124 (1947 males & 6177 females) subjects eligible for the study were recruited. Most of them are in the age range of 35 – 39 years, with a mean age of 42.02 ± 10.88 years. 7162 (88.2%) & 1771 (21.8%) of the subjects had viral suppression of <1000 RNA copies per ml and <20 RNA copies per ml respectively. The unsuppressed subjects went through enhanced adherence counselling (EAC) for three months and viral load test repeated thereafter. 192 patients who had completed the three sessions of EAC and repeated viral load increased the entire suppression numbers to 7339 (90.3%) & 1824 (22.5%) <1000 RNA copies per ml and <20 RNA copies per ml respectively during the period of observation. ART adherence has significant effect on viral load outcome from the study hypothesis tested.


Conclusion: Current ART regimen & HIV treatment enhanced adherence counseling are key to the achieving viral suppression, thus, routine viral load monitoring will ultimately help in HIV/AIDS disease progression follow up and reduce treatment failure tendencies. This will help more patients stay on first line regimen and prolong their life expectancy, indicating that the UNAIDS last 90 target is achievable.


Keywords: suppression, viral load, Nigeria, Adult

References

H. Gatanaga, K. Tsukada, H. Honda, J. Tanuma, H. Yazaki, T. Watanabe, M. Honda, K. Teruya, Y. Kikuchi and S. Oka (2009). ‘Detection of HIV Type 1 Load by the Roche Cobas TaqMan Assay in Patients with Viral Loads Previously Undetectable by the Roche Cobas Amplicor Monitor’, Clinical infectious diseases, pp. 259 – 60. doi: 10.1086/595706.

J.H. Willig, C.R. Nevin, J.L. Raper, M.S. Saag, M.J. Mugavero, A.L. Willig, J.H. Burkhardt, J.E. Schumacher and V.A. Johnson (2010). ‘Cost Ramifications of Increased Reporting of Detectable Plasma HIV-1 RNA Levels by the Roche COBAS AmpliPrep/COBAS TaqMan HIV-1 Version 1.0 Viral Load Test’, JAIDS Journal of Acquired Immune Deficiency Syndromes, 54(4), pp. 442–443. doi: 10.1097/QAI.0b013e3181d01d1d.

R.L. Hamers, C. Kityo, J.M.A. Lange, T.F.R Wit and p. Mugyenyi (2012). ‘Global threat from drug resistant HIV in sub-Saharan Africa’, BMJ, 344, pp. e4159–e4159. doi: 10.1136/bmj.e4159.

World Health Organization (WHO). Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach, Geneva. 2010.

D.E. Bennett, S. Bertagnolio, D. Sutherland and C.F. Gilks (2008). ‘The World Health Organization’s global strategy for prevention and assessment of HIV drug resistance’, Antiviral Therapy, pp. 1–13.

T. Gaolathe, K.E. Wirth, M.P. Holme, J. Makhema, S. Moyo, U. Chakalisa, E.K. Yankinda, Q. Lei, M. Mmalane, V. Novitsky, L. Okui, Q. van Widenfelt, K.M. Powis, N. Khan, K. Bennett, H. Bussmann, S. Dryden-Peterson, R. Lebelonyane, S. el-Halabi, L.A. Mills, T. Marukutira, R.Wang, E.J.T. Tchetgen, V. DeGruttola, M. Essex and S. Lockman (2016). ‘Botswana’s progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals: A population-based survey’, The Lancet HIV, 3(5), pp. e221–e230. doi: 10.1016/S2352-3018(16)00037-0.

G. Marks, U. Patel, M.J. Stirratt, M.J. Mugavero, W.C. Mathews, T.P. Giordano, N. Crepaz, L.I. Gardner, C. Grossman, J. Davila, M. Sullivan, C.E. Rose, C. O’Daniels, A. Rodriguez, A.J. Wawrzyniak, M.R. Golden, S. Dhanireddy, J. Ellison, M.L. Drainoni, L.R. Metsch and E.R. Cachay (2016). ‘Single Viral Load Measurements Overestimate Stable Viral Suppression among HIV Patients in Care: Clinical and Public Health Implications.’, Journal of acquired immune deficiency syndromes (1999), 73(2), pp. 205–212. doi: 10.1097/QAI.0000000000001036.

S. Lecher, D. Ellenberger, A.A. Kim, P.N. Fonjungo, S. Agolory, M.Y. Borget, L. Broyles, S. Carmona, G. Chipungu, K.M. De Cock, V. Deyde, M. Downer, S. Gupta, J.E. Kaplan, C. Kiyaga, N. Knight, W. MacLeod, B. Makumbi, H. Muttai and C. Mwangi (2015). ‘Scale-up of HIV Viral Load Monitoring - Seven Sub-Saharan African Countries.’, MMWR: Morbidity & Mortality Weekly Report, 64 (46), pp. 1287–1290.

J. Mermin, J.P. Ekwaru, W. Were, R. Degerman, R. Bunnell, F. Kaharuza, R. Downing, A. Coutinho, P. Solberg, L.N. Alexander, J. Tappero, J. Campbell and D.M. Moore (2011). ‘Utility of routine viral load, CD4 cell count, and clinical monitoring among adults with HIV receiving antiretroviral therapy in Uganda: randomised trial.’, BMJ (Clinical research ed.), 343(7834), p. d6792. doi: 10.1136/bmj.d6792.

S.O. Usman, O. Oluawniyi, G.P. Olubayo, T. Akinmurele, G.B. Agboola, F. Abodunde, A. Afe, O. Adeola and M. Onyema (2017). 90-90-90 Ambitious targets: achieving the last 90 of the UNAIDS targets in Western Nigeria. International STD Research & Reviews, 6(2): 1-9.

M.A. Thompson, J.A. Aberg, P. Cahn, J.S.G. Montaner, G. Rizzardini, A. Telenti, J.M. Gatell, H.F. Günthard, S.M. Hammer, M.S. Hirsch, D.M. Jacobsen, P. Reiss, D.D. Richman, P.A. Volberding, P. Yeni and R.T. Schooley (2010) ‘Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel.’, JAMA : the journal of the American Medical Association, 304(3), pp. 321–333. doi: 10.1001/jama.2010.1004.

D. Asboe, C. Aitken, M. Boffito, C. Booth, P. Cane, A. Fakoya, A.M. Geretti, P. Kelleher, N. Mackie, D. Muir, G. Murphy, C. Orkin, F. Post, G. Rooney, C. Sabin, L. Sherr, E. Smit, W. Tong, A. Ustianowski, M. Valappil, J. Walsh, M. Williams and D. Yirrell (2012). ‘British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011’, HIV Medicine, 13(1), pp. 1–44. doi: 10.1111/j.1468-1293.2011.00971.x.

Panel on Antiretroviral Guidelines for Adults & Adolescents (PAGAA) (2012). Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Washington: Department of Health and Human Services.

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How to Cite
Usman, S., Adebanjo, A., Emeh, A., Ogboghodo, E., Akinbinu, B., Udechukwu, C., Ale, J., Akueshi, C., Fatunsi, E., Ariyo, A., Suraju, A., Anugha, E., Akande, P., Owolagba, F., Jolayemi, T., & Okonkwo, P. (2020). The progress towards achieving the UNAIDS ambitious viral suppression target among adults living with HIV in South-Western Nigeria. European Journal of Medical and Health Sciences, 2(1). https://doi.org/10.24018/ejmed.2020.2.1.126