AN ASSESSMENT OF HAI-CÃ TE D’IVOIRE’S PERFORMANCE IN MEETING THE 3RD 90-UNAIDS TREATMENT GOAL OF 90% VIRAL LOAD SUPPRESSION AMONG THOSE RECEIVING ART

Abstract

UNAIDS updated treatment goal recommendations are now 95-95-95 by the year 2030. Prior to 2020, UNAIDS’ 2014 90-90-90 treatment goal indicated that 90% of all people living with HIV are aware of their HIV status, 90% of all people diagnosed with HIV will receive ART and 90% of people receiving ART will have viral suppression. Many countries were still not on track to achieving these targets. This present study was undertaken during the former 90-90-90 goals and focuses on the 3rd 90 goal of viral suppression; a WHO recommended vital indicator of ART success and detection of treatment failure. There is a strong body of evidence that viral suppression and undetectable VL levels are instrumental in the prevention of new infections via sexual transmission. Health Alliance International (HAI) is an international NGO in Côte d’Ivoire that has partnered with CDC/PEPFAR and has been in the forefront in fighting HIV/AIDS, collaborating with MSHP, Côte d’Ivoire’s Health Ministry. HAI supports more than 300 health facilities across 6 regions, in provision of HIV care and treatment services. With improved laboratory information systems, efforts continue to scale up VL monitoring in Côte d’Ivoire. Therefore, our primary aim for this study was to assess how effective HAI-led activities were, at supporting its clinical services sites in meeting the UNAIDS 3rd 90 target of VL suppression in specific regions of Côte d’Ivoire from 2015-2018. Our study showed an overall VL suppression rate of 76.4% among our study participants, higher than the 2019 estimated national rate of 50%, but lower than the initial UNAIDS recommended 90% target. Our specific Aim 1 of the evaluation was to determine the predictors of VL suppression among those taking ART, during the study period. There was varying geographic variations with rates of 75.4% in Bounkani-Gontougou, 79.7% in Gbeke, 73.0% in Hambol and 73.2% in Poro-Tchologo-Bagoue. Majority (94.1%) of the participants were adults (≥15 years) and they had a higher VL suppression than children (78.1% vs 48.5%). Majority of the patients were female (73.3%), and they had a higher VL suppression than male patients (77.4% vs 73.6%). Also, in our study, the majority of the patients (98.9%) had HIV subtype-1 (HIV-1) but patients with HIV subtype-2 (HIV-2) had a higher VL suppression rate (81.7% vs 76.3%). Patients whose blood specimens were collected and tested between 2017-2018 were significantly more likely to be virally suppressed compared to those whose samples were collected and tested earlier between 2015-2016 (76.6% vs. 75.1% respectively). Our specific Aim 2 of the evaluation was to determine the predictors of undetectable VL among those with VL suppression. In our study, the overall undetectable VL was at 69.1% among the subsample of those who were virally suppressed leaving 30.9% with detectable but suppressed VL. Adults ≥15 years of age who made up the majority of the VL suppressed subsample (96.2%) had a higher prevalence of undetectable VL (69.6% vs 55.2%). Also, virally suppressed female participants had a higher undetectable VL prevalence than their male counterparts (70.7% vs 64.4%). Undetected VL in the 4 health districts among those virally suppressed was higher in Gbeke (75.5%) than in Hambol (72.1%), Bounkani-Gontougou (70.3%) and Poro-Tchologo-Bagoue (56.5%). Our study findings suggest increased efforts are needed to help patients on ART achieve viral suppression. It is vital for strategies to be implemented that are aimed at sustaining adherence counselling of patients, close monitoring and follow-up of patients and increased access to VL testing. This could potentially lead to optimizing VL suppression rates at country level and contribute towards attaining the UNAIDS treatment goals.