Studies of viral suppression on first-line antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLHIV) in Haiti are limited, particularly among PLHIV outside of the Ouest department, where the capital Port-au-Prince is located. This study described the prevalence and risk factors for delayed viral suppression among PLHIV in all geographic departments of Haiti between 2013 and 2017. Individuals who received viral load testing 3 to 12 months after ART initiation were included. Data on demographics and clinical care were obtained from the Haitian Active Longitudinal Tracking of HIV database. Multivariable logistic regression was performed to predict delayed viral suppression, defined as a viral load ≥1000 HIV-1 RNA copies/mL after at least 3 months on ART. Viral load test results were available for 3,368 PLHIV newly-initiated on ART. Prevalence of delayed viral suppression was 40%, which is slightly higher than previous estimates in Haiti. In the multivariable analysis, delayed viral suppression was significantly associated with younger age, receiving of care in the Ouest department, treatment with lamivudine (3TC), zidovudine (AZT), and nevirapine (NVP) combined ART regimen, and CD4 counts below 200 cells/mm3. In conclusion, this study was the first to describe and compare differences in delayed viral suppression among PLHIV by geographic department in Haiti. We identified populations to whom public health interventions, such as more frequent viral load testing, drug resistance testing, and ART adherence counseling should be targeted.
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This work was supported by a grant (ID00017061) from the National Alliance of State and Territorial AIDS Directors to CD.
Data cannot be shared publicly because there are restrictions on data sharing imposed by the Haitian Ministry of Health and Population as the data contain sensitive information. Any researcher wishing to have access to the data underlying the results presented in the study can contact the Secretariat of the National HIV/AIDS Control Program (PNLS)/Ministry of Public Health and Population (firstname.lastname@example.org). The name of the database is the Haitian Active Longitudinal Tracking of HIV database (SALVH). The variables needed to replicate the analysis are: age at HIV diagnosis, sex, marital status, clinic commune, HIV diagnosis year, World Health Organization clinical stage, ART regimen, ART initiation date, CD4 and viral load tests and test dates, and history or presence of tuberculosis or sexually transmitted infections.
Rich, Shannan N.; Cook, Robert L.; Yaghjyan, Lusine; Francois, Kesner; Puttkammer, Nancy; Robin, Ermane; Bae, Jungjun; Joseph, Nadjy; Pessoa-Brandão, Luisa; and Delcher, Chris, "Risk Factors for Delayed Viral Suppression on First-Line Antiretroviral Therapy among Persons Living with HIV in Haiti, 2013-2017" (2020). Institute for Pharmaceutical Outcomes and Policy Faculty Publications. 4.
S1 Table. Demographic and clinical characteristics of persons living with HIV in Haiti by viral load test status, 2013–2017. https://doi.org/10.1371/journal.pone.0240817.s001
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S1 Fig. Distribution of viral load values by month of assessment for PLHIV with delayed viral suppression. The figure displays the mean, quartiles, minimum, and maximum log-transformed viral load values by the month of viral load test following ART initiation. These results indicate stable viral load values across each month of assessment. https://doi.org/10.1371/journal.pone.0240817.s002