Factors Associated with Viral Load Non-Suppression among People Living with HIV on Antiretroviral Therapy in Dili, Timor-Leste

Abstract

Background: The prevalence of human immunodeficiency virus (HIV) is increasing globally and regionally. Despite Timor Leste is still considered as low prevalence country with less than 0.2%, it is believed that the number of people living with HIV (PLWH) are slowly on the rise. Viral load subsequently has been introduced to evaluate the effects of antiretroviral therapy (ART), to monitor viral suppression and to detect treatment failure even in low middle income countries. There have been limited studies on the prevalence and associated factors of viral load non-suppression among PLWH in Timor-Leste. This study investigated the prevalence of viral load non-suppression among PLWH on ART and its associated factors among PLWH attending in a national hospital in Dili, Timor-Leste. Materials and Methods: Retrospective case control study was performed with all PLWH above >17 years who visited to a national hospital in Timor Leste between 2022-2023. The multiple logistic regression analysis was performed identify independent factors associated with viral load non-suppression. Results: A total of 212 subject was enrolled for this study with the mean age of 35 years old. The proportion of age group between 17-50 and >= 51 were 88% and 12%, respectively. Majority of the subject was male (72%). A total of 94 subjects (44%) had at least one episode of viral load non-suppression (>1,000 copies/mL) during study period. The multiple logistic regression analysis showed the significant factors associated with viral load non-suppression were (1) the low middle income (adjusted odds ratio [aOR], 3.403; 95% confidence interval [CI], 1.222-9.478; P=0.019), (2) the CD4+ cell counts <500 cells/mm3 (aOR, 11.622; 95% CI, 5.811-23.244; P <0.001), and (3) the opportunistic infection such as pulmonary tuberculosis (aOR, 2.382; 95% CI, 1.200-4.731; P=0.013). Conclusion: This is the first study that evaluated the prevalence of and risk factors for viral load non-suppression in Timor Leste. Low middle income status, low CD4+ cell counts and opportunistic infections were factors associated with unsuppressed viral load in this region. Regular follow-up, support and counselling for improving adherence should be encouraged to enhance viral load suppression for those PLWH.