Virologic Outcomes Following Enhanced Adherence Counselling among Treatment Experienced HIV Positive Patients at University College Hospital, Ibadan, Nigeria
International STD Research & Reviews,
Page 53-65
DOI:
10.9734/ISRR/2021/v10i130126
Abstract
Aims: To explore the impact of enhanced adherence counseling (EAC) in achieving viral suppression among our patients unsuppressed viral load in a large Anti-retroviral therapy (ART) program in South West Nigeria.
Study Design: This study was a descriptive cross-sectional review of patients’ records.
Place and Duration of Study: The study was conducted in human immunodeficiency virus (HIV) Program located in Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria involving review of data of patients with unsuppressed viral loads between 1st March 2017 – 30th September 2018.
Methodology: We described the viral loads (VL) outcomes of patients with VLs >1 000 copies/ml after at least 6 months on ART and a comprehensive 3 monthly EAC support programme. We calculated adherence using pharmacy refill data. Patients with one VL measurement after the EAC sessions were eligible for analysis.
Results: Out of 400 patients with VL >1 000 copies/ml reviewed during the study period, only 204(51.0%) were virally suppressed at the end of the 3 EAC sessions. Those with initial VLs between 1000-5000cp/ml had the highest adherence rate (73.0%) and VL suppression rate (68%). The youngest age group (16-30 years) had the least adherence (55.2%) and the least viral suppression (44.8%) while the oldest age groups (61-80years) were the most adherent (69.0%) and the most virally suppressed (55.2%). The proportion of patients on second line regimen were significantly more virally suppressed than those on the first line regimen (P <0.002).
Conclusion: This study showed the role EAC in accomplishing VL suppression and the need to intensify adherence counseling at commencement of highly active anti-retroviral therapy (HAART) to strengthen adherence in people living with HIV (PLHIV) and consequently preventing raised VL at the next laboratory testing of viral load. We strongly advocate for better measurement of adherence to antiretroviral therapy that will be accessible and reliable as this was a limitation of this study.
Keywords:
- Viraemia
- EAC
- adherence
- viral load
- pharmacy refill.
How to Cite
Awolude, O. A., Olaniyi, O., Moradeyo, M., & Abiolu, J. (2021). Virologic Outcomes Following Enhanced Adherence Counselling among Treatment Experienced HIV Positive Patients at University College Hospital, Ibadan, Nigeria. International STD Research & Reviews, 10(1), 53-65. https://doi.org/10.9734/ISRR/2021/v10i130126
References
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World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva, Switzerland: WHO Press;2013.
National guidelines for HIV prevention treatment and care. National AIDS and STIs control programme. Federal Ministry of Health, Abuja, Nigeria; 2016.
ISBN: 978-978-954-309-0.
Kim CE, Sigaloff Raph L, Hamers Carole L, Wallis Cissy Kityo, Margaret Siwale, Prudence Ive et al. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations: Two arguments for viral monitoring in Africa. J acquir Immune Defic Syndr. 2011; 58:23-31.
Bezabhe Woldesellassie M, Chalmers Leanne, Bereznicki Luke R, Peterson Gregory M. Adherence to antiretroviral therapy and virologic failure. Medicine. 2016;95(15):3361.
DOI: 10.1097/MD.0000000000003361
Knobel H, Urbina O, Gonzalez A, Sorli ML, Montero M, Carmona A, et al. Impact of different patterns of non-adherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up. HIV Med. 2009;10(6):364–369.
Martin F, Lee J, Thomson E, Tarrant N, Hale A, Lacey CJ. Two cases of possible transmitted drug-resistant HIV: Likely HIV super infection and unmasking of pre-existing resistance. Int J STD Aids. 2016; 27(1):66–69.
Cohen MS, Chen YQ, Mccauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(25):1934–1935.
Bvochora T, Satyanarayana S, Takarinda KC, Bara H, Chonzi P, Komtenza B, et al. Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues. PLoS One. 2019; 5:14(2):0211326.
DOI: 10.1371/journal.pone.0211326.
PMID: 30721229.
PMCID: PMC6363281
Gedefaw Diress, Samuel Dagne, Birhan Alemnew, Seteamlak Adane, Amanuel Addisu. Viral load suppression after enhanced adherence counseling and its predictors among high viral load HIV seropositive people in north Wollo zone public hospitals, northeast Ethiopia: Retrospective cohort study. AIDS Research and Treatment 2019; 2020:9.
Article ID: 8909232
DOI: https://doi.org/10.1155/2020/8909232
Nasuuna E, Kigozi J, Babirye L, Muganzi A, Sewankambo NK, Nakanjako D. Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda”. BMC Public Health. 2018;18(1): 1048.
Tigist Solomon, Tesfaye Gabriel. Interven tions to improve adherence to antiretroviral medications. Journal of Drug Delivery & Therapeutics. 2014;4(6):23-32.
Jani AA. Recommendation for best prac tice. Adherence to HIV Treatment. 2010; 11-39.
Available:www.apha.org/ppp/hiv
Watakakosol R. Telephone-administered intervention to improve medication adher- ence in HIV-infected rural persons. A Pilot Randomized Clinical Trial. 2010;13-80.
Beith A, A. Johnson. 2006. Interventions to improve adherence to antiretroviral therapy: A review of the evidence. Sub mitted to the U.S. agency for international development by the rational pharma ceutical management plus program. Arlington, VA: Management Sciences for Health; 2010.
Lima VD, Bangsberg DR, Harrigan PR. Risk of viral failure declines with duration of suppression on highly active antiret roviral therapy irrespective of adherence level. J Acquir Immune Defic Syndr. 2010; 55(4):60-65.
Stacey M, Lavsa Ashley, Holzworth Nicole, Ansani T. Selection of a validated scale for measuring medication adherence. Journal of the American Pharmacists Association. 2011;51(1):90-94.
Svarstad BL, Chewning BA, Sleath BL, Claesson C. The brief medication question nnaire: A tool for screening patient adherence and barriers to adherence. Patient Education & Counseling. 1999;37 (2):113–124.
John C Chalker, Tenaw Andualem, Lillian N Gitau, Joseph Ntaganira, Celestino Obua, Hailu Tadeg, et al. Measuring adherence to antiretroviral treatment in resource-poor settings: The feasibility of collecting routine data for key indicators. Chalker et al. BMC Health Services Research. 2010; 10:43.
Available: http://www.biomedcentral.com/1472-6963/10/43
Chalker J, Andualem T, Minzi O, Ntaganira J, Ojoo A, Waako P, et al. Monitoring adherence and defaulting for antiretroviral therapy in five east African countries: An urgent need for standards. JIAPAC. 2008; 7:193-199.
Barth RE, van der Loeff MF, Schuurman R, Hoepelman AI, Wensing AM. Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: A systematic review. Lancet Infect Dis. 2010;10(3):155–66.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adole scents and adults on antiretroviral therapy for HIV in Swaziland. PLoSONE. 2015; 10(2):0116144.
DOI: 10.1371/journal.pone.0116144
Arjun Banagi Yathiraj, Bhaskaran Unnikrishnan, John T. Ramapuram, Nithin Kumar, Prasanna Mithra, et al. Factors influencing adherence to antiretroviral therapy among people living with HIV in coastal south India. Journal of the International Association of Providers of AIDS Care. 2016;15(6):529–533.
Kasumu LO, Balogun MR. Knowledge and attitude towards antiretroviral therapy and adherence pattern of HIV patients in southwest Nigeria towards ART and adherence pattern of HIV patients. International Journal of Infection Control.
DOI: 10.3396/IJIC.v10i3.024.14
Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, et al. Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda. BMC Infect Dis. 2017;3;17(1):326.
DOI:10.1186/s12879-017-2428-3
PMID: 28468608.
PMCID: PMC5415758
Shilpa Viswanathan, Amy C Justice, Caleb G Alexander, Todd T Brown, Neel R Gandhi, Ian R Mc Nicholl, et al. Adherence and HIV RNA suppression in the current era of highly active antiretroviral Therapy (HAART). J Acquir Immune Defic Syndr. 2015;69(4):493–498.
Louis F, Buteau J, Francois K, Hulland E, Domerc ant JW, Yang C, et al. Virologic outcome among patients receiving antiretroviral therapy at five hospitals in Haiti. PLoS ONE. 2018;13(1):0192077.
DOI: https://doi.org/10.1371/ journal. pone. 0192077
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with virological failure and suppression after enhanced adherence counselling, in Children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS ONE. 2015;10(2):0116 144.
DOI: 10.1371/journal.pone.0116144
Oku AO, Owoaje ET, Oku OO, Monjok E. Prevalence, and determinants of adherence to highly active antiretroviral therapy amongst people living with HIV/AIDS in a rural setting in south-south Nigeria. Afr J Reprod Health. 2014;18(1):133-43.
Talaam NC, Gatongi P, Rotich S. Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS clinic at MOI teaching and refferal hospital, Eldoret, Kenya. East African Journal of Public health. 2008; 5(2):74- 78.
DB Garone, K Conradie, G Patten, M Cornell, E Goemaere, J Kunene. High rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support: A model of care in Khayelitsha, South Africa. South African Journal of HIV medicine. 2013;14(4):166-169.
Hassan AS, Nabwera HM, Mwaringa SM, et al. HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: A cross-sectional study. AIDS Res Ther. 2014;11 (1):9.
DOI:10.1186/1742-6405-11-9
Fox MP, Berhanu R, Steegen K, Firnhaber C, Ive P, Spencer D, et al. Intensive adherence counseling for HIV-infected individuals failing second-line antiretroviral therapy in Johannesburg, South Africa. Trop Med Int Heal. 2016;21(9):1131–1137.
Gibson RM, Nickel G, Crawford M, Kyeyune F, Venner C, Nankya I, et al. Sensitive detection of HIV-1 resistance to zidovudine and impact on treatment outcomes in low- to middle-income countries. Infect Dis Poverty. 2017;6(1): 163.
DOI:10.1186/s40249-017-0377-0.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with virological failure and supperssion after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS ONE 2015;10(2): 0116144.
DOI:https://doi.org/10.1371/journal.pone.0116144.
World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach. Geneva, Switzerland: WHO Press;2013.
National guidelines for HIV prevention treatment and care. National AIDS and STIs control programme. Federal Ministry of Health, Abuja, Nigeria; 2016.
ISBN: 978-978-954-309-0.
Kim CE, Sigaloff Raph L, Hamers Carole L, Wallis Cissy Kityo, Margaret Siwale, Prudence Ive et al. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations: Two arguments for viral monitoring in Africa. J acquir Immune Defic Syndr. 2011; 58:23-31.
Bezabhe Woldesellassie M, Chalmers Leanne, Bereznicki Luke R, Peterson Gregory M. Adherence to antiretroviral therapy and virologic failure. Medicine. 2016;95(15):3361.
DOI: 10.1097/MD.0000000000003361
Knobel H, Urbina O, Gonzalez A, Sorli ML, Montero M, Carmona A, et al. Impact of different patterns of non-adherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up. HIV Med. 2009;10(6):364–369.
Martin F, Lee J, Thomson E, Tarrant N, Hale A, Lacey CJ. Two cases of possible transmitted drug-resistant HIV: Likely HIV super infection and unmasking of pre-existing resistance. Int J STD Aids. 2016; 27(1):66–69.
Cohen MS, Chen YQ, Mccauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(25):1934–1935.
Bvochora T, Satyanarayana S, Takarinda KC, Bara H, Chonzi P, Komtenza B, et al. Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues. PLoS One. 2019; 5:14(2):0211326.
DOI: 10.1371/journal.pone.0211326.
PMID: 30721229.
PMCID: PMC6363281
Gedefaw Diress, Samuel Dagne, Birhan Alemnew, Seteamlak Adane, Amanuel Addisu. Viral load suppression after enhanced adherence counseling and its predictors among high viral load HIV seropositive people in north Wollo zone public hospitals, northeast Ethiopia: Retrospective cohort study. AIDS Research and Treatment 2019; 2020:9.
Article ID: 8909232
DOI: https://doi.org/10.1155/2020/8909232
Nasuuna E, Kigozi J, Babirye L, Muganzi A, Sewankambo NK, Nakanjako D. Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda”. BMC Public Health. 2018;18(1): 1048.
Tigist Solomon, Tesfaye Gabriel. Interven tions to improve adherence to antiretroviral medications. Journal of Drug Delivery & Therapeutics. 2014;4(6):23-32.
Jani AA. Recommendation for best prac tice. Adherence to HIV Treatment. 2010; 11-39.
Available:www.apha.org/ppp/hiv
Watakakosol R. Telephone-administered intervention to improve medication adher- ence in HIV-infected rural persons. A Pilot Randomized Clinical Trial. 2010;13-80.
Beith A, A. Johnson. 2006. Interventions to improve adherence to antiretroviral therapy: A review of the evidence. Sub mitted to the U.S. agency for international development by the rational pharma ceutical management plus program. Arlington, VA: Management Sciences for Health; 2010.
Lima VD, Bangsberg DR, Harrigan PR. Risk of viral failure declines with duration of suppression on highly active antiret roviral therapy irrespective of adherence level. J Acquir Immune Defic Syndr. 2010; 55(4):60-65.
Stacey M, Lavsa Ashley, Holzworth Nicole, Ansani T. Selection of a validated scale for measuring medication adherence. Journal of the American Pharmacists Association. 2011;51(1):90-94.
Svarstad BL, Chewning BA, Sleath BL, Claesson C. The brief medication question nnaire: A tool for screening patient adherence and barriers to adherence. Patient Education & Counseling. 1999;37 (2):113–124.
John C Chalker, Tenaw Andualem, Lillian N Gitau, Joseph Ntaganira, Celestino Obua, Hailu Tadeg, et al. Measuring adherence to antiretroviral treatment in resource-poor settings: The feasibility of collecting routine data for key indicators. Chalker et al. BMC Health Services Research. 2010; 10:43.
Available: http://www.biomedcentral.com/1472-6963/10/43
Chalker J, Andualem T, Minzi O, Ntaganira J, Ojoo A, Waako P, et al. Monitoring adherence and defaulting for antiretroviral therapy in five east African countries: An urgent need for standards. JIAPAC. 2008; 7:193-199.
Barth RE, van der Loeff MF, Schuurman R, Hoepelman AI, Wensing AM. Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: A systematic review. Lancet Infect Dis. 2010;10(3):155–66.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adole scents and adults on antiretroviral therapy for HIV in Swaziland. PLoSONE. 2015; 10(2):0116144.
DOI: 10.1371/journal.pone.0116144
Arjun Banagi Yathiraj, Bhaskaran Unnikrishnan, John T. Ramapuram, Nithin Kumar, Prasanna Mithra, et al. Factors influencing adherence to antiretroviral therapy among people living with HIV in coastal south India. Journal of the International Association of Providers of AIDS Care. 2016;15(6):529–533.
Kasumu LO, Balogun MR. Knowledge and attitude towards antiretroviral therapy and adherence pattern of HIV patients in southwest Nigeria towards ART and adherence pattern of HIV patients. International Journal of Infection Control.
DOI: 10.3396/IJIC.v10i3.024.14
Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, et al. Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda. BMC Infect Dis. 2017;3;17(1):326.
DOI:10.1186/s12879-017-2428-3
PMID: 28468608.
PMCID: PMC5415758
Shilpa Viswanathan, Amy C Justice, Caleb G Alexander, Todd T Brown, Neel R Gandhi, Ian R Mc Nicholl, et al. Adherence and HIV RNA suppression in the current era of highly active antiretroviral Therapy (HAART). J Acquir Immune Defic Syndr. 2015;69(4):493–498.
Louis F, Buteau J, Francois K, Hulland E, Domerc ant JW, Yang C, et al. Virologic outcome among patients receiving antiretroviral therapy at five hospitals in Haiti. PLoS ONE. 2018;13(1):0192077.
DOI: https://doi.org/10.1371/ journal. pone. 0192077
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with virological failure and suppression after enhanced adherence counselling, in Children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS ONE. 2015;10(2):0116 144.
DOI: 10.1371/journal.pone.0116144
Oku AO, Owoaje ET, Oku OO, Monjok E. Prevalence, and determinants of adherence to highly active antiretroviral therapy amongst people living with HIV/AIDS in a rural setting in south-south Nigeria. Afr J Reprod Health. 2014;18(1):133-43.
Talaam NC, Gatongi P, Rotich S. Factors affecting antiretroviral drug adherence among HIV/AIDS adult patients attending HIV/AIDS clinic at MOI teaching and refferal hospital, Eldoret, Kenya. East African Journal of Public health. 2008; 5(2):74- 78.
DB Garone, K Conradie, G Patten, M Cornell, E Goemaere, J Kunene. High rate of virological re-suppression among patients failing second-line antiretroviral therapy following enhanced adherence support: A model of care in Khayelitsha, South Africa. South African Journal of HIV medicine. 2013;14(4):166-169.
Hassan AS, Nabwera HM, Mwaringa SM, et al. HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: A cross-sectional study. AIDS Res Ther. 2014;11 (1):9.
DOI:10.1186/1742-6405-11-9
Fox MP, Berhanu R, Steegen K, Firnhaber C, Ive P, Spencer D, et al. Intensive adherence counseling for HIV-infected individuals failing second-line antiretroviral therapy in Johannesburg, South Africa. Trop Med Int Heal. 2016;21(9):1131–1137.
Gibson RM, Nickel G, Crawford M, Kyeyune F, Venner C, Nankya I, et al. Sensitive detection of HIV-1 resistance to zidovudine and impact on treatment outcomes in low- to middle-income countries. Infect Dis Poverty. 2017;6(1): 163.
DOI:10.1186/s40249-017-0377-0.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors associated with virological failure and supperssion after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PLoS ONE 2015;10(2): 0116144.
DOI:https://doi.org/10.1371/journal.pone.0116144.
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