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    Jan 17, 2021
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    Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India

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    Name:
    Laxmeshwar et al 2020 Routine ...
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    Authors
    Laxmeshwar, C
    Acharya, S
    Das, M
    Keskar, P
    Pazare, A
    Ingole, N
    Mehta, P
    Gori, P
    Mansoor, H
    Kalon, S
    Singh, P
    Mathur, T
    Ferlazzo, G
    Isaakidis, P
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    Issue Date
    2020-05-05
    Submitted date
    2020-07-09
    
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    Journal
    PloS One
    Abstract
    Background Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Médecins Sans Frontières has provided routine VL measurements and EAC to PLHA on ART at King Edward Memorial (KEM) hospital, Mumbai since October-2016. This study aims to describe the initial VL results and impact of EAC on viral suppression and factors associated with initial viral non-suppression among patients with an initial detectable VL, in a cohort of patients tested between October-2016 and September-2018. Methods This is a descriptive study of PLHA on ART who received VL testing and EAC during October-2016 to September-2018. Log-binomial regression was used to identify factors associated with a high VL. Results Among 3849 PLHA who underwent VL testing, 1603(42%) were female and median age was 42 years (IQR:35–48). Majority were referred for routine testing (3432(89%)) and clinical/immunological failure (233(6%)). Overall, 3402(88%) PLHA had suppressed VL at initial testing. Among 3432 tested for routine monitoring, 3141(92%) had VL suppressed. Of 291 with VL>1000c/ml, 253(87%) received EAC and after repeat VL, 70(28%) had VL<1000c/ml. Among 233 referred for clinical/immunological failure, 122(52%) had VL>1000c/ml and 109 have been switched to second-line ART. CD4 count<500 (aOR-5.0[95%CI 3.8–6.5]), on ART for<5 years (aOR-1.5[1.1–2.0]) and age<15 years (aOR-5.2[3.0–8.9]) were associated with an initial VL>1000c/ml. Factors associated with follow-up VL suppression included EAC (p<0.05) and being on second-line ART (p<0.05). Conclusion Results from a routine VL program in public sector in India were encouraging and in line with UNAIDS 90-90-90 targets. Routine VL monitoring along with EAC resulted in early switch to alternative optimised regimens while also preventing unnecessary switches. Along with the vital scale up of routine VL monitoring, implementation of enhanced adherence strategies for patients with detectable viral load should be ensured.
    Publisher
    Public Library of Science
    URI
    http://hdl.handle.net/10144/619679
    DOI
    10.1371/journal.pone.0232576
    PubMed ID
    32369504
    Type
    Article
    Language
    en
    EISSN
    1932-6203
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0232576
    Scopus Count
    Collections
    HIV/AIDS

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