Viral load suppression after enhanced adherence counseling among HIV patients on antiretroviral therapy (2019-2024): a systematic review and meta-analysis in East Africa.

INTRODUCTION

Viral load suppression is essential for reducing human immunodeficiency virus (HIV) related morbidity and mortality. To eliminate the HIV epidemic and enhance adherence to antiretroviral therapy (ART) globally, the Joint United Nations Program on HIV/AIDS and the World Health Organization (WHO) recommend enhanced adherence counseling (EAC) for individuals with a viral load above 1000 copies/ml. EAC helps identify and address adherence barriers, assisting patients in recognizing challenges and developing an effective plan to achieve viral load suppression. It also enables early detection of ART failure, ensuring a timely and appropriate switch to second-line medications.

METHOD: We conducted a systematic review and meta-analysis by performing comprehensive literature search in PubMed, Google Scholar, Hinari-Research4life, and Since Direct to identify relevant articles. Data were extracted via an Excel spreadsheet (version 5.1) and then imported into STATA (version 17.1) for analysis. A random-effects model was applied to the pooled effect of the outcomes, with a 95% confidence interval, which was visualized using a forest plot. Heterogeneity was assessed via I2 statistics, and publication bias was examined through a funnel plot and Egger's test (p < 0.05) to determine statistical significance.

RESULTS

This systematic review and meta-analysis included eleven primary studies with a total of 4488 participants. The pooled rate of viral load suppression after enhance adherence counseling among HIV patients on ART was 63% [95%CI: ( 55-71)], with significant heterogeneity (I2-100, p = 0.00). The funnel plot showed asymmetry, and Egger's test result of 0.8104 indicated no publication bias. A leave-one-out analysis revealed that all studies fell within the 95% CI of the pooled rate, suggesting that no single study significantly influenced the overall estimate. In the subgroup analysis the viral load suppression rate was 61% [95% CI: (55-66)] in Ethiopia, and 69% [95%CI: ( 49-90)] in Uganda and it ranged from 63% across all age groups to70% in adult HIV patients.

CONCLUSION

The rate of viral load suppression following enhanced adherence counseling among HIV patients on antiretroviral therapy(ART) in East Africa was 63%.This value is significantly below the 95% target set by the WHO and UNAIDS under the 95-95-95 framework, emphasizing a substantial gap in achieving the desired outcome of viral load suppression in this region.