# Time to viral load suppression after enhanced adherence counseling among HIV patients attending antiretroviral therapy in Southwest Ethiopia

## TL;DR

This study examines how quickly HIV patients in Ethiopia achieve viral load suppression after receiving enhanced adherence counseling and identifies factors that influence this outcome.

## Contribution

The study provides new evidence on the effectiveness of enhanced adherence counseling in achieving viral load suppression in HIV patients in Ethiopia.

## Key findings

- The incidence of viral load non-suppression was 12.19 per 100 person-months.
- Receiving CPT, HIV status disclosure, ART adherence, and absence of opportunistic infections predicted faster viral load suppression.
- The median time to suppression was shorter than in previous Ethiopian studies.

## Abstract

Enhanced adherence counseling (EAC) is given to patients with high viral loads (over 1000 copies/ml) to improve Antiretroviral Therapy (ART) adherence, with sessions occurring monthly for three months. A follow-up viral load test is conducted afterwards, but there is a lack of evidence on the impact of EAC on viral load reduction, highlighting the need for further research.

This study aimed to assess the time to viral load suppression and its predictors among clients receiving EAC at Mattu Karl Comprehensive Specialized Hospital and public hospitals in Gambella town, southwest Ethiopia, 2024.

A retrospective follow-up study was conducted among 403 randomly selected patients on EAC at Gambella town hospitals and Mettu Karl Comprehensive Specialized Hospital from January 2019 to December 2023. Data were extracted from patient records and analyzed using STATA. Both bivariate and multivariable survival models were used, with a Cox proportional hazard model to identify predictors for viral load suppression. A p-value < 0.05 was considered statistically significant.

The incidence density rate of viral load non-suppression among ART-attending patients was 12.19 (95% CI: 10.9–13.6) per 100 person-months. In the multivariable survival analysis, participants who received Cotrimoxazole Preventive Therapy(CPT) (adjusted HR = 1.55 (95% CI: 1.0–2.3)), disclosed their HIV status (adjusted HR = 1.62 (95% CI: 1.1–2.3)), had fair adherence to ART (adjusted HR = 1.8 (95% CI: 1.1–3.1)), and had no opportunistic infections (adjusted HR = 2.13 (95% CI: 1.3–6.1)) were independent predictors of viral load suppression.

The study found a lower median time to viral load suppression compared to previous Ethiopian studies. Key predictors of suppression included receiving CPT, disclosing HIV status, adhering to ART, and not having opportunistic infections. Emphasis should be placed on providing CPT, encouraging status disclosure, and improving opportunistic infection management.