BACKGROUND: Viral load (VL) suppression remains a challenge to achieving epidemic control in most sub-Saharan Africa. Although Ghana made significant progress in the third 95 from 68% in 2019 to 79% in 2022, further insight into the factors associated with VL suppression is critical to inform clinical counseling and care approaches, client-level VL literacy and demand generation activities. This study investigates the factors associated with viral suppression among people living with HIV (PLHIV), using retrospective data from a large cohort.
METHODS: We conducted a retrospective analysis of 14,777 HIV clients with viral loads results on the National HIV database system (E-tracker). We extracted two years of clients’ data (2020-2022) on the 15th January, 2023 for Western, Western North and Ahafo regions. A stepwise regression model was used to determine factors associated with viral load suppression among HIV clients with VL results. The outcome variable was VL status (suppressed, unsuppressed).
RESULTS: Among the 14,777 clients with VL results, 76% were females. The mean age of the study population was 42. From the results, 13,116 representing 88% of the clients were virally suppressed (<1000 copies/mL). Clients who were currently active on ART were 1.8 times more likely to be virally suppressed compared to those who interrupted treatment (OR=1.8, CI=1.6-2, p<0.001). Clients on multi-month dispensing (MMD) were 2.3 times more likely to be virally suppressed compared to single month dispensing (OR=2.6, CI=2.0-2.5, p<0.001). Clients-initiated at hospitals had higher odds of experiencing viral load suppression than clients initiated at lower level facilities, i.e., clinics [(OR=1.7, CI=1.1-2.6, p=0.02)]. For every one-year increase in age, there was a 1.7 timely increase in VL suppression (OR=1.0, CI=1.0-1.1, p<0.001). Males were 0.8 times less likely to be virally suppressed (OR=0.8, CI=0.7-0.9, p<0.001).
CONCLUSIONS: Our study found that uninterrupted ART, hospital initiation, MMD, and age were positively associated with VL suppression among HIV clients, while being male was negatively associated. Scale-up of Ghana’s differentiated service delivery policy, which provides for MMD scale up and addresses the inherent challenges faced by sub populations including males and younger clients, is key to achieving VL suppression nationwide.

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