SEARCHCOHORTinfectious disease, public health

cohort·infectious disease, public health, epidemiology, internal medicine, observational study·PMC10406184

Impact of intensive adherence counseling on viral load suppression and mortality among people living with HIV in Kampala, Uganda: A regression discontinuity design

PLOS Global Public Health · 7 authors, 7 centres

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TL;DR

This regression discontinuity study evaluated intensive adherence counseling (IAC) among people living with HIV with viral load ≥1,000 copies/ml on first-line ART in Kampala, Uganda. Within an optimal bandwidth of 236 participants, those receiving IAC had significantly lower odds of repeat viral load suppression compared to those receiving routine psychosocial support.

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This quasi-experimental regression discontinuity study assessed the effect of intensive adherence counseling (IAC) on viral load (VL) suppression and all-cause mortality among 3,199 people living with HIV on first-line ART in Kampala, Uganda. Sensitivity analyses confirmed robustness across varying bandwidths.

STUDY TYPE

cohort

SPECIALTY

infectious disease

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AI pipeline

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ORIGINAL PAPER

PMC10406184

Impact of intensive adherence counseling on viral load suppression and mortality among people living with HIV in Kampala, Uganda: A regression discontinuity design

PLOS Global Public Health

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ABSTRACT

Abstract Intensive adherence counseling (IAC) is recommended for people living with HIV (PLHIV) with viral load (VL) ≥1,000 copies/ml after ≥6 months of anti-retroviral therapy (ART). We evaluated the effect of IAC on VL suppression and all-cause mortality among PLHIV on first-line ART with VL ≥1,000 copies/ml after ≥6 months of ART in Kampala, Uganda using regression discontinuity design, a quasi-experimental method for effect estimation when interventions depend on a cut-off. PLHIV just above VL ≥1,000 copies/ml cut-off who received ≥3 IAC sessions formed the intervention group while those just below the cut-off who received routine psychosocial support constituted the control group. Primary outcome was repeat VL suppression defined as VL <1,000 copies/ml approximately 9–12 months following initial VL assessment. Secondary outcome was all-cause mortality. We used logistic regression for causal-effect analysis, reported as odds ratio (OR) with a 95% confidence interval (CI). We performed sensitivity analyses to assess the robustness of findings to varying bandwidths at the cut-off. We found 3,735 PLHIV were started on ART between Nov 2020 and Nov 2021 of whom 3,199 were included in the analysis (3,085 control, 114 intervention). Within an optimal bandwidth, there were 236 participants (222 control, 14 intervention) with similar demographic and clinical characteristics. Repeat VL suppression was lower in the intervention than in the control group (85.7% versus 98.6%, p = 0.021) while all-cause mortality was similar (0% versus 0.5%, p = 1.000). In multivariable analysis, the odds of repeat VL suppression were 91% lower in the intervention than control group (OR = 0.09; 95% CI, 0.01–0.66). Findings are robust to varying bandwidths around the cut-off. We concluded IAC is ineffective in suppressing VL among PLHIV on first-line ART in Kampala, Uganda. Findings suggest a need to investigate the IAC implementation fidelity for successful translation in practice and the reasons for VL persistence beyond the suppression threshold.

CITATION EXPORT

Jonathan Izudi, Barbara Castelnuovo, Rachel King et al.. Impact of intensive adherence counseling on viral load suppression and mortality among people living with HIV in Kampala, Uganda: A regression discontinuity design. PLOS Global Public Health. (2023). https://doi.org/10.1371/journal.pgph.0002240

AUTHORS

7 · 7 CENTRES

Jonathan Izudi, Barbara Castelnuovo, Rachel King, Adithya Cattamanchi, Henry Zakumumpa, Henry Zakumumpa, Henry Zakumumpa

1Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
2University of California Global Health Institute (UCGHI), University of California, San Francisco, San Francisco, CA, United States of America
3African Population and Health Research Center (APHRC), Nairobi, Kenya
4Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
5Center for Tuberculosis, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States of America
6Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, Irvine, CA, United States of America
7Makerere University, UGANDA