Background
Antiretroviral therapy (ART) improves clinical outcomes of people living with HIV (PLHIV) and achieving viral suppression through ART can prevent HIV transmission. We compared prevalence and correlates of unsuppressed viral load among PLHIV from two Tanzania HIV Impact Surveys (THISs). The first (survey 1 [S1]) was conducted from October 2016-August 2017; the second (survey 2 [S2]) was conducted from November 2022-March 2023.
Methods
THISs were independent, cross-sectional household surveys with a stratified cluster design. Consenting participants aged ≥15 years were administered a questionnaire and tested for HIV in the household. HIV-positive specimens were tested for viral load (VL). We used chi-square tests and pooled sampling weights to assess the change in prevalence of unsuppressed VL (VL ≥1000 copies/mL) among PLHIV between surveys. Logistic regression models were used to assess factors associated with unsuppressed VL for each survey. We report results as prevalence (%) or adjusted odds ratio (aOR) with 95% confidence intervals (CI); analyses are weighted and account for complex survey design.
Results
We analyzed data from 1,830 (S1) and 1,849 (S2) participants aged ≥15 years living with HIV. The proportion of PLHIV with unsuppressed VL decreased significantly from 48.1% (95%CI: 44.9-51.4%) in S1 to 22.0% (95%CI: 19.6-24.6%) in S2. Prevalence of unsuppressed VL decreased in all age and sex groups; the decrease was greatest in males aged 15-24 years (77.8% [52.9-91.6%] in S1 to 28.5% [13.0-51.4%] in S2) and smallest in females aged 15-24 years (52.9% [43.1-62.4%] in S1 to 45.5% [33.4-58.0%] in S2) (Figure). In both surveys, male sex (S1 aOR 2.1 [1.6-2.7]; S2 aOR 1.8 [1.3-2.5]) and younger age (15-24 years S1 aOR 3.2 [1.9-5.1]; S2 aOR 4.1 [2.1-8.1]) were significantly associated with increased odds of unsuppressed VL, compared to females and those aged ≥50 years, respectively. Alcohol use was associated with unsuppressed VL in S1 only (aOR 1.4 [1.1-1.9]). Education and wealth were not significantly associated with unsuppressed VL in either survey.
Conclusions
Prevalence of unsuppressed VL among PLHIV decreased by over half in the 6-year period between THIS surveys, demonstrating progress towards the UNAIDS global target of 95% of PLHIV on ART are virally suppressed. Targeted approaches to address unsuppressed VL among young females (aged 15-24 years) and males (aged ≥25 years) may help achieve the third UNAIDS 95 target among all age and sex groups in Tanzania.