Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India

Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Médecins Sans Frontières has provide...

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Bibliographic Details
Published in:	PloS one Vol. 15; no. 5; p. e0232576
Main Authors:	Laxmeshwar, Chinmay, Acharya, Shrikala, Das, Mrinalini, Keskar, Padmaja, Pazare, Amar, Ingole, Nayana, Mehta, Preeti, Gori, Pooja, Mansoor, Homa, Kalon, Stobdan, Singh, Pramila, Mathur, Taanya, Ferlazzo, Gabriella, Isaakidis, Petros
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 05-05-2020 Public Library of Science (PLoS)
Subjects:	Acquired immune deficiency syndrome AIDS AIDS (Disease) Antiretroviral drugs Antiretroviral therapy Arts centers Biology and Life Sciences CD4 antigen Counseling Failure HIV HIV patients Hospitals Human immunodeficiency virus Immunology Medical diagnosis Medicine and Health Sciences Monitoring Patients People and Places Public art Public sector Switches India South Africa Mumbai India Southern Africa
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Summary:	Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Médecins Sans Frontières has provided routine VL measurements and EAC to PLHA on ART at King Edward Memorial (KEM) hospital, Mumbai since October-2016. This study aims to describe the initial VL results and impact of EAC on viral suppression and factors associated with initial viral non-suppression among patients with an initial detectable VL, in a cohort of patients tested between October-2016 and September-2018. This is a descriptive study of PLHA on ART who received VL testing and EAC during October-2016 to September-2018. Log-binomial regression was used to identify factors associated with a high VL. Among 3849 PLHA who underwent VL testing, 1603(42%) were female and median age was 42 years (IQR:35-48). Majority were referred for routine testing (3432(89%)) and clinical/immunological failure (233(6%)). Overall, 3402(88%) PLHA had suppressed VL at initial testing. Among 3432 tested for routine monitoring, 3141(92%) had VL suppressed. Of 291 with VL>1000c/ml, 253(87%) received EAC and after repeat VL, 70(28%) had VL<1000c/ml. Among 233 referred for clinical/immunological failure, 122(52%) had VL>1000c/ml and 109 have been switched to second-line ART. CD4 count<500 (aOR-5.0[95%CI 3.8-6.5]), on ART for<5 years (aOR-1.5[1.1-2.0]) and age<15 years (aOR-5.2[3.0-8.9]) were associated with an initial VL>1000c/ml. Factors associated with follow-up VL suppression included EAC (p<0.05) and being on second-line ART (p<0.05). Results from a routine VL program in public sector in India were encouraging and in line with UNAIDS 90-90-90 targets. Routine VL monitoring along with EAC resulted in early switch to alternative optimised regimens while also preventing unnecessary switches. Along with the vital scale up of routine VL monitoring, implementation of enhanced adherence strategies for patients with detectable viral load should be ensured.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0232576