Clinico-microbiological investigation of factors contributing to suboptimal viral suppression among HIV/AIDS patients on sustained antiretroviral treatment in the upper east region of Ghana.

INTRODUCTION: HIV remains a major global health challenge, with approximately 48.1 million people affected worldwide and nearly 69% residing in sub-Saharan Africa. Regional disparities remain in Ghana, especially in the Upper East Region, which continues to lag behind the national target rates for viral suppression, despite advances made in expanding access to antiretroviral therapy (ART). This study aimed to examine the clinical factors associated with sub-optimal viral suppression to guide efforts to meet the UNAIDS 95 95 95 targets.

METHODS: A cross sectional survey was carried out with 281 HIV positive persons on sustained ART in three major health institutions. Structured questionnaires, clinical record review, and laboratory tests such as hematology, liver function, renal function, metabolic syndrome, and microbiological testing were used for data collection. Viral load results were stratified into four categories: Target Not Detected (TND, <20 copies/mL), optimal suppression (20-199 copies/mL), suboptimal suppression (200-999 copies/mL), and virological failure (≥1,000 copies/mL). Chi-square tests and logistic regression were used for statistical analyses to identify associated factors.

RESULTS: The findings showed that 69.4% of the participants achieved TND, 7.8% had optimal suppression, 17.8% obtained suboptimal suppression, and 5.0% had virological failure. Suppression outcomes were significantly different for ART regimen (p = 0.001): patients receiving AZT/3TC/NVP were more likely to achieve TND than those receiving TLD (AOR = 1.42, 95% CI: 1.11-2.34). Duration on ART also influenced suppression (p = 0.03): people who were on ART for 11-15 years were more likely to be well-suppressed (AOR = 1.56, 95% CI: 1.08-2.25) than those on ART for 1-5 years. Oddly enough, defaulters had paradoxically higher odds of TND (AOR = 1.31, p = 0.036). Biochemical markers such as total protein (AOR = 1.47, p = 0.042) and albumin/globulin ratio (AOR = 1.52, p = 0.029) were found to be significantly associated with suppression. Systemic infections (bacteremia and urinary tract infections) had a tendency toward worse outcomes but the relationship was not statistically significant.

CONCLUSION: ART regimen, treatment duration, ART adherence history and biochemical markers were found to be important factors of viral suppression in the Upper East Region.