Are you suppressed? Viral load test coverage for people living with HIV in Mutare District, Manicaland Province, Zimbabwe, 2015-2017 Investigators

Abstract Background: The third 90-90-90 UNAIDS goal require that 90% of people living with HIV (PLHIV) on antiretroviral treatment (ART) achieve viral load (VL) suppression. This study assessed the proportion of VL suppression and related factors among PLHIV on 1 st and 2 nd line ART in Mutare District, Manicaland Province, Zimbabwe between 2015-2017. Methods: A retrospective study using routine HIV programme data from the electronic monitoring system for nine health facilities in Mutare District. VL suppression was defined as < 1,000 copies/ml. Results: Of 16,590 registered patients, 15,566(94%) were on first-line and 1024(6%) on second-line ART. Of those on 1 st -line ART, 2856(18%) had a VL test result documented, while 367(36%) of 2 nd -line ART patients had VL results. VL suppression rates were 86% among those on 1 st -line and 45% in 2 nd -line ART. Independent risk factors associated with VL non-suppression for those on 1 st -line ART were age 0-9 years (adjusted relative risk, aRR=2.9; 95% confidence interval, CI=1.7-4.8;P<0.001), 10-19 years (aRR=2.2;95%CI=1.4-3.2,P<0.001) compared to those 20-49 years, concurrent TB (aRR=9; CI=3.0-29.7,P<0.001) and male gender (aRR=1.5,95%CI=1.1-2.1;P=0.02). There were no significant risk factors associated with VL non-suppression for 2 nd -line ART patients. Conclusion: For PLHIV on 1 st -line ART in Mutare district, Manicaland, Zimbabwe, the frequency of reported VL results were only 18% among those on 1 st -line ART, while the rate of VL suppression was near 90%. Viral Load testing coverage appears to be lagging behind current Zimbabwe goals and increased support is needed to improve the quality of HIV care and help reduce the threat of possible HIV drug resistance in the future.