Viral Load Trends And Viral Suppression Rates In Kwale Sub County Hospital

BACKGROUND:

Human immunodeficiency virus is a burden to Kenya with previous regime declaring it a national disaster on November 1999.kwale sub county hospital has a catchment population of 9558;.the WHO requirement for 90:90:90 is being worked on with the current status being80.9 suppressed  and 19.1 not suppressed;. Total PLWIA and enrolled into care at Kwale sub county hospital are 478.

Viral load test is done to monitor the effectiveness of treatment or to establish the ability of ARV drug to suppress the virus. Viral suppression will lead to increased CD4 levels and competent immunity. Monitoring viral load trends in patients is key since its one of the ways to detect resistance of the virus to drugs. The increased VL counts primarily are due to poor drug adherence, patients absconding clinics i.e. dafaughters etc. This gives the virus an opportunity to mutate so as to resist treatment with the drug. This will lead to shifting to second line and probably 3rd line drugs if no proper mitigation is put in place. The strains which are resistant to first line will develop and contracted to new infections. This put at risk affordable and sustainable management of HIV and AIDS.

OBJECTIVES

1. To determine the causes of high viral load levels in patients
2. To identify ways increasing viral suppression.
3. To identify drug resistance trends in patients no viral suppression.

METHODS:

The data was collected from May 2017 to February 2018. A total of 10 months. This data was obtained from laboratory document VL tracking register ;patient CCC files  and from the NASCOP VL website.

Patients with noted high VL copies were identified. And also their records tracked so as to identify the trends. It was then analyzed,

RESULTS:

During this time it was discovered that a total of 525 patients were tested.in this men were 141 [26.9%] and female were 384[73.1%].this shows that females are more enrolled into care than males.

Total with viral suppression were 441 [84%] male 106[87.2%] and female 335[76%].this is below the target 90:90:90 strategy .viral suppression is impressive in ladies as compared to males.

Total with no viral suppression were 84 with [16%] male 35[24.8%] and female 49[12.8%].lack of suppression is high in males than ladies.

Some of the noted viral load trends which are wanting include:

1:    1942c/ml:1402c/ml:5148c/ml:4504c/ml:1480c/ml

6:   2279c/ml:215625c/ml:36831c/ml

14: 28032c/ml:10502c/ml:385225c/ml

17: 5911c/ml:1493c/ml:15613c/ml:2122c/ml

42: 3715c/ml:20063c/ml:79994c/ml

43: 28032c/ml:10502c/ml:385225c/ml

65: 1060c/ml:1134c/ml:……..:2791c/ml:3095c/ml

From the analysis of the files:

CONCLUSION:

1. 90:90:90 strategy not met;
2. Females are more enrolled into care than males
3. Viral suppression rate is high in females than males. This may be due to adherence.
4. There is risk that the new infections may be managed with second line drugs due to mutation later resistance
5. HIV management may soon turn to be costly due to resistance.
6. Public to be empowered with more knowledge on HIV to minimize cases of adherence to drugs.