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Abstract
Statement of the problem. The 90-90-90 UNAIDS targets to measure the progress toward HIV control were not achieved globally in 2020, with significant differences between countries. Many low- and middle-income countries in sub-Saharan Africa, including the DRC, had the worst outcomes. These target shortfalls suggest continued HIV transmission, mortality, and morbidity. This study examines the factors associated with adherence to ART and viral load suppression among PLHIV to contribute to the control of HIV and address the lack of research evidence in Likasi. Methods. A cross-sectional study was carried out in 2021 among adult HIV patients taking ART in 42 health facilities in Likasi. Adherence to ART was measured using self-report and was categorized as adherent and not adherent. Viral load level was the most recently measured value, and viral load suppression was defined using the 1000 copies/mL WHO cut-off. Using SAS software, bivariate and multivariate logistic regression analyses were performed to determine the socio-demographic, clinical, and facility factors associated with 1) adherence to ART and 2) viral load suppression.
Results. 82% of PLHIV was adherent to ART, and 74% suppressed their viral load. Adherence was most likely among those who 1) disclosed their status, 2) were in health facilities of > 459 patients, and 3) were in health facilities with very good hospitality. Adherence was less likely among patients 1) who disclosed to their partners, 2) who were in secondary levels facilities, and 3) in Kikula health zone. The likelihood of suppressing viral load was higher in 1) adherent patients and 2) those who disclosed their HIV status. Subjects with an NGO support group and those from a secondary-level facility were less likely to suppress their viral load.
Conclusions. Likasi is behind in achieving the UNAIDS viral load suppression goal. Several factors impact ART adherence and viral load suppression. The health system management, policymakers, and practitioners could target these factors for improvement and contribute to the achievement of the 95-95-95 UNAIDS targets. This first assessment of the factors associated with ART adherence and viral load suppression in Likasi fills the existing literature gap and calls for further studies.