Background
In low-and middle-income countries (LMIC), mortality among adolescents living with HIV(ADLHIV) is still concerning, driven by poor viral suppression(VS) in the frame of limited adherence monitoring approaches. We herein evaluated the virological outcomes after enhanced adherence counselling (EAC) among ADLHIV with non-VS and low-level viremia (LLV) in the era of tenofovir-lamivudine-dolutegravir (TLD) in Cameroon.
Methods
In the frame of the CIPHER-ADOLA project, we conducted a multicenter facility-based cohort-study among ADLHIV(10-19 years) in Cameroon. Three EAC sessions were provided to ADLHIV with a viral load (VL)≥50 copies/ml for a period of 3-months. VS, low-level viremia (LLV) and virological failure(VF) were defined as VL<1000, 50-999 and ≥1000 copies/mL, respectively. The outcome after EAC among ADLHIV with LLV and VF was respectively to achieve undetectability and VS.
Results
Of 252 ADLHIV enrolled for VL testing, 70 (27.8%) had a VL≥50 copies/ml (female:58.6%, median [IQR] age: 15 [13-17]). Pre-TLD backbones included ABC+3TC (50.0%), TDF+3TC (41.4%) and AZT+3TC (8.6%); median TLD-duration was 23.5 [±11.6] months. Before EAC, 72.9% (51/70) had poor ART-adherence; 44.6% and 55.4% had VLs 50-999 and ≥1000, respectively. At the end of follow-up, 60.7% had good adherence; with higher-rates of adherence associated with being female (22/37 [59.4%]) versus male (15/26 [57.7%];p=0.889) and attending all 3 EAC-sessions (57.1% [32/56] vs 42.9%[24/56],p=0.001). Among the 56 ADLHIV with available VLs post-EAC, 58.9%, 19.6% and 21.4% had VLs<50, 50-999 and ≥1000, respectively, indicating an overall 33% reduction in poor VS. Interestingly, among ADLHIV with VL≥1000 at baseline, 70% achieved VS and 30% experienced VF after EAC. In LLV group at baseline, 74% had a VL<50 and 26% remain in LLV. Despite a non-significant decline in median VL (126[52-1871] post-EAC versus 135[95-8519] at baseline,p=0.945), viral non-suppression and LLV significantly declined from 55.4% to 21.4% (p=0.0002) and 44.6% to 19.6% (p=0.0046) respectively after EAC. Overall,73.2% significant decline in VLs (-0.5 log10 RNA) was observed between pre- and post-EAC.
Conclusions
In LMICs transitioning to TLD, an effective EAC would substantially improve ART outcomes among ADLHIV experiencing non-VS. In context, LMICs are encouraged to accompany the transition to pediatric dolutegravir-containing regimens with a robust adherence support strategy for ADLHIV with detectable VL to achieve elimination of pediatric AIDS by 2030.