Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Autoři: Patience Atuhaire aff001;  Sherika Hanley aff002;  Nonhlanhla Yende-Zuma aff003;  Jim Aizire aff004;  Lynda Stranix-Chibanda aff005;  Bonus Makanani aff006;  Beteniko Milala aff007;  Haseena Cassim aff008;  Taha Taha aff004;  Mary Glenn Fowler aff009
Působiště autorů: Makerere University-Johns Hopkins University (MU-JHU) Kampala, Uganda aff001;  Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, Nelson R. Mandela School of Medicine, Durban, South Africa aff002;  Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa aff003;  Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States of America aff004;  University of Zimbabwe College of Health Sciences Department of Paediatrics and Child Health, Harare, Zimbabwe aff005;  Malawi College of Medicine-John's Hopkins Research Project, Blantyre, Malawi aff006;  University of North Carolina (UNC) Project, Lilongwe, Malawi aff007;  Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa aff008;  Johns Hopkins University, Departments of Pathology and Epidemiology, Baltimore, MD, United States of America aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0219415



Despite recent efforts to scale-up lifelong combination antiretroviral therapy (cART) in sub-Saharan Africa, high rates of unsuppressed viremia persist among cART users, and many countries in the region fall short of the UNAIDS 2020 target to have 90% virally suppressed. We sought to determine the factors associated with unsuppressed viremia (defined for the purpose of this study as >200 copies/ml) among sub-Saharan African women on lifelong cART.


This cross-sectional analysis was based on baseline data of the PROMOTE longitudinal cohort study at 8 sites in Uganda, Malawi, Zimbabwe and South Africa. The study enrolled 1987 women living with HIV who initiated lifelong cART at least 1–5 years ago. Socio-demographic, clinical, and cART adherence data were collected. We used multivariable Poisson regression with robust variance to identify factors associated with unsuppressed viremia.


At enrolment, 1947/1987 (98%) women reported taking cART. Of these, HIV-1 remained detectable in 293/1934 (15%), while 216/1934 (11.2%) were considered unsuppressed (>200 copies/ml). The following factors were associated with an increased risk of unsuppressed viremia: not having household electricity (adjusted prevalence risk ratio (aPRR) 1.74, 95% confidence interval (CI) 1.28–2.36, p<0.001); not being married (aPRR 1.32, 95% CI 0.99–1.78, p = 0.061), self-reported missed cART doses (aPRR 1.63, 95% CI 1.24–2.13, p<0.001); recent hospitalization (aPRR 2.48, 95% CI 1.28–4.80, p = 0.007) and experiencing abnormal vaginal discharge in the last three months (aPRR 1.88; 95% CI 1.16–3.04, p = 0.010). Longer time on cART (aPRR 0.75, 95% CI 0.64–0.88, p<0.001) and being older (aPRR 0.77, 95% CI 0.76–0.88, p<0.001) were associated with reduced risk of unsuppressed viremia.


Socioeconomic barriers such as poverty, and individual barriers like not being married, young age, and self-reported missed doses are key predictors of unsuppressed viremia. Targeted interventions are needed to improve cART adherence among women living with HIV with this risk factor profile.

Klíčová slova:

Dose prediction methods – Malawi – Uganda – Viral load – Viremia – Zimbabwe


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