AUTHOR=Kafwanka Powell , Nalule Flavia Muyinza , Michelo Charles 

TITLE=Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1094214

DOI=10.3389/fpubh.2023.1094214

ISSN=2296-2565

ABSTRACT=Background: COVID-19-related disruptions in healthcare services and clinical outcomes have been predicted and documented. However, little is known about how antiretroviral therapy (ART) adherence disruptions caused by the COVID-19 pandemic have manifested amidst the Undetectable = Untransmittable (U=U) campaign initiative. This study aimed to determine the adherence to ART among adult people living with HIV on first-line ART medications at the University Teaching Hospital in Lusaka, Zambia during the COVID-19 pandemic.
Methods: This was a hospital-based cross-sectional study. Secondary data of PLWHIV registered to receive ART from the UTHs Adult Infectious Disease Centre was extracted from the SmartCare® electronic health record system to constitute a resultant data set that this study used. The data extraction form was used to extract values of dependent and independent variables and imported them into the statistical analysis tool, STATA version 16.1 MP. Descriptive statistics of individual characteristics, testing for associations using Pearson's chi-square test and stratified and combined multivariable logistic regression were performed.
Results: Of the 7,281 adult PLWHIV included in this study, 9.0% (95% CI 8.3% - 9.6%) were virally detectable. Estimates of the odds ratios of detectable viral load remained significantly higher among adult PLWHIV who were initiated on ART after the U=U campaign was launched in Zambia and were on a monthly 2.51 (1.31-9.03), or 6-monthly 4.75 (3.52-6.41) dispensing of dolutegravir-based first-line regimen and those on 6-monthly dispensing of efavirenz-based first-line regimen 4.67 (2.16-10.08) compared to their counterparts. Overall estimates showed us the same picture 4.14 (3.22-5.31), having adjusted for all other predictor variables.
Conclusion: We report a high proportion of people with detectable viral load in the study population irrespective of ART refill interval and type of ART regimen concentrated among adult PLWHIV who started ART during the COVID-19 epidemic waves. This observed disparity suggests the inherent impact of the COVID-19 pandemic on the adherence to ART among adult PLWHIV in Lusaka, Zambia. This further illustrates how exposed program responses are to external shocks, especially in already weak health systems, and the need to create program response buffers and resilient program-specific strategies to minimize the effect of external disruptions.