ArticlePLOS global public health2025
Viral suppression and associated factors after enhanced adherence counseling among people living with HIV with unsuppressed viral loads at tertiary and first-level health facilities in Zambia: A retrospective cohort study.
Article in PLOS global public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
People living with HIV (PLHIV) who do not achieve viral suppression on antiretroviral therapy contribute to HIV transmission. Poor adherence is a major factor associated with high viral load (VL). Enhanced adherence counseling (EAC) is a targeted intervention to improve adherence and achieve viral suppression, but data on post-EAC outcomes in Zambia remain limited. This study assessed viral suppression and associated factors among PLHIV with unsuppressed VL after completion of EAC at University Teaching Hospital and Kanyama First-Level Hospital. This retrospective cohort study analyzed VL register data from 1st January 2021-31st December 2023. Baseline demographic, clinical, and laboratory data were collected, with follow-up VL measurements at three and 12 months post-EAC. The primary outcome was viral suppression at three months, defined as a VL < 200 copies/mL. Poisson regression with robust standard errors identified factors associated with suppression. Among 386 participants (median age 39 years, IQR: 31-47), 52.9% were female. The baseline VL was 21,600 copies/mL (IQR: 3,692-106,000). At three months post-EAC, 85% (330/386) achieved viral suppression, with 95.8% (316/330) maintaining suppression at 12 months. Viral rebound occurred in 4.2% (14/330). EAC delivered through both telephone and in-person methods increased suppression likelihood by 15% compared to those who received EAC in-person (physical) alone. Prior enrollment in six-month multi-month dispensing (MMD) was associated with a 23% increased likelihood of suppression compared to those who had never received MMD. Participants on tenofovir/lamivudine/dolutegravir were 29% more likely to suppress compared to those on zidovudine/lamivudine/dolutegravir. EAC modestly improves and sustains viral suppression among PLHIV with high viral loads. In-person and telephone-based EAC improved viral suppression by 15% compared to in-person alone. Other key factors influencing suppression were community-based delivery and prior six-month MMD. Findings highlight opportunities to integrate technology-enhanced adherence support and differentiated service delivery models to optimize HIV care outcomes.
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