Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa.
We describe the prevalence of inadequate virological response (IVR) to ART (viral load ≥ 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews.
The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR.
Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.
From the *Institute for Health and Social Policy-McGill University, Montreal, Quebec, Canada; †Département de Médecine Sociale et Préventive-Université de Montréal, Montreal, Canada; ‡Département de Microbiologie et Immunologie-Université de Montréal, Montreal, Canada; §Clinique Médicale L'Actuel, Montréal, Quebec, Canada; ‖Hôpital National du Point G-Unité de Médecine Interne, Bamako, Mali; ¶Centre Universitaire Hospitalier Yalgado-Ouédraogo-Unité de Dermatologie, Ouagadougou, Burkina Faso; #Centre Universitaire Hospitalier Yalgado-Ouédraogo-Unité de Médecine Interne, Ouagadougou, Burkina Faso; **Hôpital Gabriel Touré, Bamako, Mali; ††Centre de soins, d'animation et de conseils pour les personnes atteintes du VIH/SIDA (CESAC), Bamako, Mali; and ‡‡Unité de Santé Internationale-Université de Montréal, Montreal, Canada.
Received for publication January 3, 2008; accepted April 24, 2008.
Supported by the Canadian Institute of Health Research (Canadian Institute for Health Research-Recherche in Institut de Recherche en Santé du Canada).
Presented at the XVI International AIDS conference, August 13-18, 2006, Toronto.
Correspondence to: Catherine Boileau, PhD, Institute for Health and Social Policy-McGill University, 1130 Pine Avenue West, Montréal, Québec, Canada H3A 1A3 (e-mail: firstname.lastname@example.org).