Factors associated with viral load non-suppression among adults with HIV in Sughd region, Tajikistan: a retrospective cohort study.

BACKGROUND

Viral load suppression among people living with HIV is a key strategy for reducing HIV transmission. A global target for HIV elimination aims to have 95% of people living with HIV diagnosed, 95% of people diagnosed on antiretroviral therapy (ART), and 95% viral load suppression for those on ART. We aimed to assess viral load non-suppression rates and associated factors among people living with HIV on ART in the Sughd region of Tajikistan.

METHODS

We conducted a retrospective cohort study of adults (≥ 18 years old) who were newly diagnosed with HIV in 2013–2022 and had received ART for ≥ 6 months in the Sughd Region. Data were collected from the national electronic HIV case surveillance system and cross-referenced with paper medical and laboratory records. We conducted multivariable Quasi-Poisson regression to identify factors associated with viral load non-suppression (defined as ≥ 1000 copies/mL on their latest viral load test).

RESULTS

Among the 1,871 people newly diagnosed with HIV who received ART for ≥ 6 months from 2013 to 2022, 11% were not virally suppressed. Over half (57%) were male, 38% were migrants, 73% were married, and the median age was 31 years (range 18–74). One-third (32%) had advanced HIV disease at diagnosis, 58% had been on ART for < 5 years, 94% were on a dolutegravir-containing regimen (DTG), and 9% died. Viral load non-suppression was 23% among people with stage IV at diagnosis and 43% among those not on DTG. Higher risk of viral load non-suppression was observed among male migrants and male nonmigrants compared to female nonmigrants (adjusted relative risk [aRR] and 95% confidence interval = 1.61 [1.13–2.31] and aRR = 1.48 [1.03–2.14], respectively), those who never-married vs. married (aRR = 1.56 [1.05–2.25]), those on ART for < 5 years vs. longer (aRR = 1.56 [1.05–2.29]), those initiating ART in 2013–2018 compared to 2019–2020 (aRR = 1.92 [1.28–2.88]), and those not on DTG (aRR = 3.86 [2.63–5.69]).

CONCLUSIONS

Viral load suppression among people living with HIV in the Sughd Region remains below the global 95% target. Viral load suppression may improve with increased treatment support for people with late diagnosis or those newly initiating ART, with a special focus on men and migrants.