Correlates of viral load suppression among people living with HIV on antiretroviral treatment in Mbujimayi, Democratic Republic of Congo: a cross-sectional study

Correlates of viral load suppression among people living with HIV on antiretroviral treatment in Mbujimayi, Democratic Republic of Congo: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlates of viral load suppression among people living with HIV on antiretroviral treatment in Mbujimayi, Democratic Republic of Congo: a cross-sectional study Désiré Baloji, Alain Mpanya, Georges Ntambwe, Bertin Mukuna Nyembo, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9330574/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Context Acquired immunodeficiency syndrome (AIDS) remains a major global public health concern and one of the leading causes of mortality worldwide. Lifelong antiretroviral therapy (ART) enables viral load suppression or undetectability, reducing the risk of opportunistic infections and improving survival. However, some individuals fail to achieve viral suppression, and understanding the associated factors is critical. This study aimed to identify key determinants of successful viral suppression among people living with HIV (PLWH) on ART. Methods A cross-sectional study was conducted in Mbujimayi, Democratic Republic of Congo, involving 561 PLWH from ten healthcare facilities with available viral load results. Data on ART adherence, sexual behavior, and sociodemographic characteristics were collected. Viral load served as the primary outcome. Variables with p < 0.20 in bivariate analysis were included in a multivariable modified binomial logistic regression model to adjust for confounders. Statistical significance was set at p < 0.05. Results Participants had a median age of 49 years (IQR: 18) and a median ART duration of 9 years (IQR: 7); 66.31% were female, and 67.56% were in WHO clinical stage 3. Condom use was reported by 67.91%, while 84.3% had no casual sexual partners; 91.78% abstained from alcohol, and 86.45% adhered to ART. Multivariable analysis identified ART adherence (AOR 11.743 [95% CI: 4.153–33.204], p < 0.001), absence of casual sexual partners (AOR: 2.179 [95% CI: 1.221–3.888], p = 0,008 ), and condom use AOR: 1.764 [95% CI: 1.144–2.721], p = 0.010), and ART duration (AOR: 1.590 [1.086–2.328], p = 0.045) as significant predictors of viral suppression. However, no alcohol consumption was a protective factor (AOR: 0.486 [95% CI: 0.240–0.985]). Conclusion Strict ART adherence and stable sexual behaviors (absence of casual sexual partners, condom use) were associated with viral suppression. Strengthening health education and psychosocial support programs to promote adherence and safe sexual practices could improve treatment outcomes. These findings provide evidence to guide public health strategies for HIV management in resource-limited settings. Suppression Viral load PLWH ART Mbujimayi Figures Figure 1 BACKGROUND Acquired immunodeficiency syndrome (AIDS) remains a major global public health challenge and has been one of the leading causes of mortality worldwide since the onset of the epidemic. Between its emergence and 2021, approximately 40.1 million people died from AIDS-related illnesses [ 1 ]. With improved access to prevention, diagnosis, treatment, and care, infection with the human immunodeficiency virus (HIV) has increasingly been managed as a chronic condition, allowing many individuals to live longer and healthier lives. The advent of antiretroviral therapy (ART) has transformed the trajectory of the epidemic, offering hope for better control. However, access to ART remains problematic in many low- and middle-income countries [ 2 ]. In these settings, ART is predominantly delivered through primary care facilities, where laboratory capacity for viral load monitoring is limited, health systems often lack the ability to act on viral load results, and evidence-based interventions to strengthen adherence are scarce [ 2 , 3 ]. According to the WHO and CDC, sustained adherence to ART is the key determinant of viral load suppression and reduced transmission risk. Yet, long-term adherence in resource-limited settings is hindered by multiple patient- and program-related barriers, including poverty, food insecurity, alcohol and tobacco use, poor quality of life, sexual behaviors, forgetfulness, limited knowledge, treatment interruptions, distance to health facilities, and the cost of care [ 4 ]. Suboptimal adherence or treatment interruptions can lead to viral rebound, undermining the benefits of long-term ART [ 4 – 6 ]. Conversely, individuals who achieve viral suppression experience stronger immune recovery, improved clinical outcomes, and reduced mortality [ 7 ]. Moreover, maintaining an undetectable viral load eliminates the risk of sexual transmission to HIV-negative partners, a principle captured in the Undetectable or Untransmittable campaign [ 7 , 8 ]. Despite these advances, a proportion of patients continue to struggle with achieving or maintaining viral suppression [ 9 ]. In the Democratic Republic of Congo (DRC), studies conducted in Kinshasa and Haut Katanga reported viral suppression rates ranging from 62% to 92.5%, with undetectable viral load levels between 53% and 56.4% [ 4 , 10 , 11 ]. According to national estimates from the HIV/AIDS Control Program (PNLS/PNMLS), only 19% of PLWH had a suppressed viral load, far below the UNAIDS 95-95-95 targets [ 12 ]. Social determinants of health—including depression, adverse events, self-efficacy, and social support—also play critical roles in adherence and viral suppression [ 9 ]. Poor engagement in care, particularly during the early stages of treatment, is strongly associated with inadequate adherence [ 9 ]. In East Kasai Province, where Mbujimayi is located, monitoring ART effectiveness remains particularly challenging. Provincial laboratories lack the capacity to perform viral load testing, limiting systematic surveillance and hindering timely clinical interventions such as adherence counseling [ 13 ]. In accordance with the national policy for integrated HIV/AIDS care in DRC and WHO recommendations for viral load monitoring among PLWH on ART specifically, an initial test six months after treatment initiation, followed by a second test at 12 months (six months after the first). After two consecutive undetectable results, RNA testing is performed annually [ 14 – 16 ]. However, significant gaps persist in resource-limited contexts, particularly in the East Kasai province. This study aimed to identify the factors associated with viral load suppression among people living with HIV receiving highly active antiretroviral therapy (HAART) in Mbujimayi, Democratic Republic of Congo. By clarifying these determinants, the study seeks to contribute to improved patient follow-up and to reducing HIV-related morbidity and mortality. MATERIALS AND METHODS Study Design and Setting We conducted a cross-sectional study to document the factors that can influence viral load suppression of PLWH to ART in the Mbujimayi city, the capital of East Kasai Province in the Democratic Republic of the Congo. Mbujimayi town comprises 10 of East Kasai Province's 19 health zones. We conducted our study at 10 healthcare facilities in Mbujimayi (Hospital Bonzola Hospital, Dipumba Hospital currently Clinique Universitaire de Mbujimayi, Presbyterian Hospital, Kansele Hospital, Kayembe Hospital, Saint Franciscans Hospital, Bena Cibuabua Center, Camp Nsele Center and Centre Nyongolo Center), which care for PLWH and have viral load results. Study population The target population of the study was HIV-positive people on ART attending HIV/AIDS treatment and diagnosis centers in the city of Mbujimayi. Given the constraints related to the achievement of the viral load (VL), the accessible population on which we worked was composed of PLWH attending the targeted hospitals and organizing the VL between the study period. Study eligibility criteria Inclusion criteria The inclusion criteria for the study participants were individuals who met the following conditions: all HIV patients on antiretroviral treatment who received a viral load in the selected facilities during the study period. Non-inclusion criteria All PLWH were not receiving antiretroviral therapy (ART) at the study period; patients who did not undergo a viral load test during the study period, patients followed up in health facilities not selected for the study and individuals with incomplete or missing data regarding HIV status, ART regimen, or viral load results. Sample size We estimated the sample size using the Fleiss formula for two proportions [ 17 ]: N = \(\:\frac{\text{[}{\text{Z}}_{\text{α}}\sqrt{\text{p}\left(\text{1-}\text{p}\right)\text{(}\frac{\text{1}}{{\text{q}}_{\text{1}}}\text{+}\frac{\text{1}}{{\text{q}}_{\text{2}}}}\text{)\:+\:}{\text{Z}}_{\text{β}}\sqrt{{\text{p}}_{\text{1}}\left(\text{1-}\text{P}\text{1}\right)\frac{\text{1}}{{\text{q}}_{\text{1}}}\text{+}{\text{p}}_{\text{2}}\left(\text{1-}\text{P}\text{2}\right)}\frac{\text{1}}{{\text{q}}_{\text{2}}}\text{}{\text{]}}^{\text{2}}}{{\text{(}\text{P}\text{2-}\text{P}\text{1)}}^{\text{2}}}\) where p1 is the proportion of patients with a suppressed viral load, 0.19 [ 12 ], and p2 is the expected proportion of no suppressed patients in the study (35%). We set the power at 80% (Zβ = 0.84) and the confidence interval at 95% (Zα = 1.96) with a no suppressed/suppressed ratio of 2:1. Consequently, the initial estimated sample size was approximately 561 PLWH on ART, including 187 suppressed PLWH and 374 no suppressed PLWH. Data collection Investigators were recruited in Mbujimayi based on their availability, educational background, and adherence to the principal investigator’s guidelines. Prior to data collection, they underwent comprehensive training on the use of the data collection tool. The training covered the study context, specific objectives, case definitions, and operational acronyms. Additionally, ethical and cultural considerations, appropriate dress code, and professional conduct during fieldwork were emphasized. Potential factors that could influence data quality were also discussed to ensure methodological rigor. We used a data collection grid in PLWH files. Data collection took place from November 7, 2022, to January 9, 2023. Pretesting of the data collection tool (questionnaire) was carried out in two healthcare facilities (Muya Hospital and Christ-Roi Hospital) before the actual data collection was launched in the selected care facilities. Final modifications were made to the data collection tool immediately after the pretest, and enumerators were reassessed for suitability; unsuitable enumerators were automatically excluded from the study. Given that our main source of data was the records of PLWH on targeted ART in health facilities, and supplemented by interviewing patients about missing elements in the record, we were able to select PLWH who had achieved a viral load and whose result was available, respecting the ratio of 1 suppressed for 2 not suppressed. Once selected, cases were approached by investigators or research assistants at the earliest opportunity. Study variables and measurements The primary objective of this study was to identify predictors of viral load suppression, defined as a viral load of ≤ 1000 RNA copies per milliliter of blood. This criterion aligns with the World Health Organization (WHO) guidelines and the standard measurement used in the Democratic Republic of Congo (DRC) [ 14 – 16 ]. To ensure consistency and accuracy, the most recent viral load result was used for analysis; thus, a single RNA measurement served to define viral load suppression. In addition to viral load suppression, the analysis considered several explanatory variables, including sociodemographic, economic, and HIV-related clinical factors. Sociodemographic variables included sex, age, geographic origin, main activities (occupation), socioeconomic status, education, marital status, household size, presence of a stable and/or occasional partner, and alcohol and tobacco use. Clinical variables included duration on ART, WHO clinical stage, ART regimen, tuberculosis co-infection, condom use, and ART adherence. ART adherence was defined as correct and consistent intake of prescribed antiretroviral drugs. Adherence was assessed using patient medical records and confirmed through self-report during interviews. Participants were classified as adherent (≥ 95% of doses taken) or non-adherent [ 14 , 16 ]. The ART regimen used by all patients included in this study consists of a combination of two nucleoside reverse transcriptase inhibitors (tenofovir and lamivudine) and one integrase inhibitor (dolutegravir), in accordance with the integrated HIV management guidelines in the DRC. These variables were selected based on their epidemiological relevance and documented association with viral load suppression in the scientific literature. They were categorized according to international standards to ensure comparability and analytical robustness. Data management The data were initially received in a Microsoft Excel format and subsequently imported into Stata 17 for further processing and analysis. In Stata, variables were meticulously constructed and defined in accordance with the specified measurements and parameters of the study. To ensure the integrity and reliability of the dataset, a rigorous data cleaning process was undertaken. This process commenced with the execution of descriptive statistical analyses to identify any anomalies, errors, inconsistencies, or missing values within the dataset. Observations with missing data points pertaining to the outcome variable were systematically excluded from subsequent analyses. This step was undertaken to maintain the robustness and validity of the analytical procedures employed. Statistical analysis Data were analyzed using Stata statistical software, version 17. Descriptive analysis was conducted; wherein continuous variables such as age, ART duration and household size were presented as medians with interquartile range (IQR). Categorical variables were summarized as frequencies and percentages with their 95% IC. Bivariable analysis was conducted using the chi-square test for all dichotomized variables. Factors that were significant at p ≤ 0.2, such as profession, provenance, casual sexual partner, condom use, smoking, alcoholism, pulmonary tuberculosis, clinical stage, ART duration and adherence, were further evaluated in the multivariable binomial logistic regression model to adjust for measured confounding factors and predict the variability of the response as a function of the explanatory variable. Adjusted odds ratios (AOR) was estimated with their 95% CI to measure the strength of the associations between the independent variables considered and the suppression of the viral load. All variables with a p ≤ 0.05 were considered statistically significant and retained in the final model. RESULTS Characteristics of study participants. This table shows that the median age of PLWH on ART is 49 years (IQR: 19). The median household size is 5 persons (IQR: 4), and the median duration on ART is 9 years (IQR: 7). Participants were 66.31% female, 48.48% married, and 81.11% had a secondary education level. Employment was reported by 52.58%, 89.48% resided in the urban area of Mbujimayi, and 93.94% had low socioeconomic status. A stable sexual partner was reported by 48.66% and a casual sexual partner by 15.69%. Smoking was observed in 14.08% and alcohol consumption in 8.02%. Pulmonary tuberculosis was present in 57.40%, and 67.56% were classified as WHO stage III. Condom use was reported by 67.91%. All participants were on the TDF/3TC/DTG (TLD) regimen, with good adherence achieved in 86.45% (Table 1 ). Table 1 Sociodemographic and economic characteristics and clinical and therapeutic variables Variables N = 561 % [95%CI] Median (Q1 – Q3) Age (year) 49 (39–57) years [15–49] 296 52.76 [48.63–56.86] Beyond 49 265 47.24 [43.14–51.37] Household size (person) 5 (3–7) [0–5] 339 60.43 [56.32–64.39] Beyond 5 222 39.57 [35.61–43.68] Duration ART (year) 9 (6–13) years [0–9] 297 52.94 |48.80–54.04] [Beyond 9] 264 47.06 [42.96–51.20] Viral load (copy/ml) [≤ 40] 164 29.23 [25.62–33.13] [41–1000] 23 4.10 [2.75–6.08] [Beyond 1000] 374 66.67 [62.66–70.44] Sex Female 372 66.31 [62.30–70.10] Male 189 33.69 [29.90–37.70] Marital status Single 86 15.33 [12.59–18.55] Married 272 48.48 [44.37–52.62] Widower 155 27.63 [24.09–31.47] Divorced 48 8.56 [6.51–11.16] Education Uneducated 13 2.32 [1.36–3.92] Primary 59 10.52 [8.24–13.33] Secondary 455 81.11 [77.66–84.13] Higher and University 34 6.06 [4.37–8.35] Main activities (occupation) Employees 295 52.58 [48.45–56.69] Nonemployees & others 266 47.42 [43.31–51.55] Place of residence Urban 502 89.48 [86.67–91.76] Rural 59 10.52 [8.24–13.33] Socioeconomic status Low 527 93.94 [91.65–95.63] Average 34 6.06 [4.37–8.35] Stable sexual partner Yes 273 48.66 [44.55–52.79] No 288 51.34 [47.21–55.45] Casual sexual partner Yes 88 15.69 [12.91–18.93] No 473 84.31 [81.07–87.09] Smoking Yes 79 14.08 [11.45–17.21] No 482 85.92 [82.79–88.55] Alcohol use Yes 45 8.02 [6.05–10.57] No 516 91.98 [89.43–93.95] Pulmonary tuberculosis Yes 322 57.40 |53.27–61.43] No 239 42.60 [38.57–46.73] WHO disease stage Stage I 11 1.96 [1.10–3.48] Stage II 105 18.72 [15.71–22.15] Stage III 379 67.56 [63.58–71.30] Stage IV 66 11.76 [9.35–14.69] Condoms use Yes 381 67.91 [63.94–71.64] No 180 32.09 [28.36–36.06] ART adherence Yes 485 86.45 [83.37–89.04] No 76 13.55 [10.96–16.63] Viral load suppression Yes 187 33.33 [29.56–37.34] No 374 66.67 [62.66–70.44] Prediction factors with viral load suppression among people living with HIV. The bivariate analysis revealed a statistically significant relationship between nonexistence of casual sexual partners (p = 0.005), condom use (p = 0.0011), pulmonary tuberculosis (p = 0.013), clinical stage (p = 0.32), duration of ART (p = 0.004) and adherence (p < 0.001) with viral load suppression (Table 2 ). In the Multivariate analysis with binomial logistic regression model, the absence of a casual sexual partner (AOR: 2.179 [95% CI: 1.211–3.888], p = 0.008), condom use (AOR: 1.764 [95% CI: 1.144–2.721], p = 0.010), duration of ART beyond 9 years (AOR: 1.590 [1.086–2.328], p = 0.017), and adherence (AOR: 11.743 [4.153–33.204], p < 0.001) were significant factors associated with viral load suppression in PLWH on ART. Alcohol abstinence was also a protective factor (AOR: 0.486 [0.240–0.985], p = 0.045). (Table 2 ). Table 2 Prediction factors (bivariate analysis and multivariate analysis with binomial logistic regression) Variables Viral load suppression Yes (n = 187) No (n = 374) COR [95%CI] p AOR [95%CI] p Age [15–49] 94 (31.76) 202 (68.24) 0.861 [0.606–1.223] 0.403 Beyond 49 93 (35.09) 172 (64.91) 1 Sexe Female 118 (31.72) 254 (68.28) 0.869 [0.559–1.167] 0.260 Male 69 (36.51) 120 (63.49) 1 Marital Status Living alone (single, widowed, divorced) 97 (33.56) 192 (66.44) 1.022 [0.719–1.452] 0.905 Married 90 (33.09) 182 (66.91) 1 Instruction Uneducated & Primary 21 (29.17) 51 (70.83) 0.801 [0.466–1.377] 0.422 Secondary & High/University 166 (33.95) 323 (66.05) 1 Household size (person) [0–5] 110 (32.45) 229 (67.55) 0.905 [0.632–1.294] 0.583 Beyond 5 77 (34.68) 145 (65.32) 1 Profession Employees 109 (36.95) 186 (63.05) 1.412 [0.991–2.013] 0.056 1.280 [0.808–1.915] 0.208 Nonemployees & others 78 (29.32) 188 (70.68) 1 1 Place of residence Urban 174 (34.66) 328 (65.34) 1.877 [0.987–3.569] 0.052 1.412 [0.712–2.801] 0.323 Rural 13 (22.03) 46 (77.97) 1 1 Socioeconomic status Law 177 (33.59) 350 (66.41) 1.214 [0.568–2.594] 0.617 Average 10 (29.41) 24 (70.59) 1 Stable sexual partner Yes 91 (33.33) 182 (66.67) 1.00 [0.704–1.421] 1.000 No 96 (33.33) 192 (66.67) 1 Casual sexual partner Yes 18 (20.45) 70 (79.55) 1 1 No 169 (35.73) 304 (64.27) 2.162 [1.246–3.751] 0.005 2.179 [1.221–3.888] 0.008 Condoms use Yes 144 (37.80) 237 (62.20) 1.936 [1.297–2.889] 0.0011 1.764 [1.144–2.721] 0.010 No 43 (23.89) 137 (76.11) 1 1 Smoking Yes 32 (40.51) 47 (59.49) 1 1 No 155 (32.16) 327 (67.84) 0.696 [0.427–1.134] 0.145 0.895 [0.514–1.556] 0.694 Alcohol Yes 21 (46.67) 24 (53.33) 1 1 No 166 (32.17) 350 (67.83) 0.542 [0.293–1.002] 0.068 0.486 [0.240–0.985] 0.045 Pulmonary tuberculosis Yes 121 (37.58) 201 (62.42) 1.578 [1.098–2.267] 0.013 1.413 [0.947–2.107] 0.090 No 66 (27.62) 173 (72.38) 1 1 WHO disease stage Stage 1 & 2 29 (25.00) 87 (75.00) 1 1 Stage 3 & 4 158 (35.51) 287 (64.49) 1.652 [1.040–2.624] 0.032 1.578 [0.956–2.605] 0.075 ART duration (years) [0–9] 83 (27.95) 214 (72.05) 1 1 Beyond 9 104 (39.39) 160 (60.61) 1.676 [1.177–2.387] 0.004 1.590 [1.086–2.328] 0.017 ART adherence Yes 183 (37.73) 302 (62.27) 10.907 [3.920–30.352] < 0.001 11.743 [4.153–33.204] < 0.001 No 4 (5.26) 72 (94.74) 1 ROC Curve The area under the curve (AUC) values indicated that the ability to predict viral load suppression among PLWH was approximately 72.5% (AUC: 0.725 [95% CI: 0.682–0.769], p < 0.001) (Fig. 1 ). DISCUSSION This study highlights the following: the factors associated with viral load suppression in our study were adherence, the absence of an occasional sexual partner and condoms use. In our work, we found that therapeutic adherence was 86.45%, whereas nonadherence was 14.55%. Abdullahi et al. (2020), in their 2020 work in Ethiopia, reported that 36.1% of participants had low adherence and that poor adherence was associated with a 10-fold increased risk of an unsuppressed viral load [ 18 ]. The difference between the two studies may be explained by variations in treatment regimens and patient follow-up. In our setting, simplified therapeutic strategies and consistent monitoring likely contributed to better adherence. These findings reinforce the importance of optimized treatment and strengthened follow-up to improve compliance and reduce treatment failure. Several studies have highlighted considerable variability in ART adherence, for instance, Ladak et al. (2019) reported adherence rates exceeding 95% [ 19 ]. In contrast, Touzard Romo et al. (2014) documented fluctuations between 2003 and 2010, with adherence ranging from 67% to 86% [ 20 ]. Moreover, Kalichman et al. (2014), found that 47% of patients did not adhere properly to ART, and identified alcohol consumption, lack of medication and certain social situations as contributing factors [ 21 ]. In previous studies on the determinants of suppression or no suppression of the viral load, the authors consistently reported increased risks of no suppression in people with poor adherence to therapy [ 18 , 21 – 23 ]. A high viral load is observed in people with poor adherence because an optimal drug concentration is needed to control viral replication. It has been reported that 95% or more adhesion is required for sustained viral suppression [ 18 , 24 ]. Viral load suppression among PLWH on ART is influenced by several factors, including coinfections, specific ART regimen, suboptimal adherence, drug resistance, and the stage of infection [ 25 ]. Consistent adherence is critical to achieving and sustaining suppression. Although, alcohol consumption has often been studied in relation to adherence, its direct effect on viral suppression has received less attention. Evidence from India showed that improved adherence was the main determinant of suppression, with 88% of PLWH achieving viral load suppression despite 48% initially experiencing clinical or immunological failure [ 26 ]. Nevertheless, the emergence of ART-resistant strains demonstrates that even patients with good adherence may fail to achieve suppression, as resistance frequently results from a history of poor adherence [ 21 ]. In our series, we found that adherence was significantly associated with viral load suppression (p < 0.001). Good adherence was associated with approximately a seven-fold greater likelihood of achieving viral load suppression (IRR 6.956 [95% CI: 2.579–18.763). This result highlights interest and reinforces the need to improve adherence and therapeutic compliance at a high level, more than 90%, to ensure the sustained and lasting effectiveness of the ART for the suppression of the viral load. Previous studies have shown that good adherence, duration of ART, and disclosure of status are factors in viral load suppression [ 10 , 21 , 26 – 28 ]. A study conducted in 2022 in Kinshasa and Upper Katanga in the DRC before and after COVID-19 by Shah et al . revealed that viral load suppression was associated with the timing of ART initiation (AOR: 2.50), female sex (AOR: 1.23), rural residence (AOR: 1.83), and the timing of the last visit (AOR: 1.50) [ 11 ]. However, homelessness and lack of moral support [ 29 ], male sex, initiation of ART < 15 years, treatment for tuberculosis, duration of one year and more than 10 years under ART [ 30 ], drug and alcohol use [ 19 ], poor adherence to therapy [ 9 , 31 ], and nevirapine-based treatment [ 32 ] are associated with no suppression of the viral load and/or rebound. In East Kasai Province in the DRC, 19% of HIV patients on ART had access to a viral load test [ 13 ]. This low rate of access is explained by the difficulty in supplying inputs to the provincial laboratory, thus having a negative impact on the follow-up of patients. Currently, many more than 1000 unanalyzed samples are at the National Institute for Biomedical Research, possibly because either the influx of samples or the samples are not taken in the standards and are unanalyzable. We believe that if the provincial laboratory was supplied with inputs to achieve a viral load, PLWH would be monitored without any problems, which would lead to better monitoring of patients [ 13 ]. The absence and/or absence of an occasional sexual partner was significantly associated with viral load suppression (AOR: 2,179 [95% CI: 1,221–3,888], p = 0.008. Although the mechanisms underlying this situation were not explored in our study, it is possible that individuals with greater adherence to ART may also be more selective in their sexual partnerships, thereby contributing to improved adherence and more consistent follow-up. However, this hypothesis cannot be confirmed with the current analysis. This statistical association highlights the need for further research to clarify the influence of relational contexts on adherence and viral suppression among PLWH. We also found that condom use (AOR: 1,764 [95% CI: 1,144–2,721]) and the duration of treatment beyond 9 years (AOR: 1,590 [95% CI: 1,086 − 2,328]) were also factors in viral load suppression in PLWH. In contrast, alcohol was a protective factor (AOR: 0.486 [95% CI: 0.240–0.985]). Some authors found factors in their study that predicted viral load suppression. These factors include a longer duration of antiretroviral treatment (> 3 years) [ 33 ], WHO stage I diagnosis, good adherence to antiretroviral therapy, nevirapine-based treatment and increasing duration of treatment [ 34 ]; women and people with higher levels of education [ 35 ]; and reduced alcohol consumption [ 36 ]. In contrast, our study identified therapeutic adherence, condom use, and the absence of casual sexual partners as the only factors associated with viral suppression. This variation may reflect the particular characteristics of the study population and the limitations inherent in a cross-sectional design, which restricts the ability to capture additional clinical or socio-demographic predictors. On the other hand, the probability of viral load suppression was lower in people who had been on antiretroviral therapy for 36 to 59 months [ 35 ]. Occasional and frequent heavy drinking is associated with viral no suppression [ 37 – 39 ]. The authors also showed that the association was not statistically significant when restricted to people on antiretroviral treatment, suggesting that the relationship between alcohol consumption and viral suppression is explained by the use of antiretroviral treatment [ 38 ]; young people aged 15–29 years, among men, people reporting irregular condom use with nonmarital/casual partners versus people with marital/permanent partners only [ 39 ]. Other authors have reported a no association between abusive, hazardous, harmful and dependent alcohol consumption and HIV viral suppression [ 40 , 41 ]. A meta-analysis revealed that on the basis of scientific evidence and high-quality data, the risk of sexual transmission of HIV is negligible when an HIV-positive sexual partner is on antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/ml, measured every 4–6 months. Sexual transmission of HIV occurs when the viral load is above 200 copies/ml with antiretroviral therapy or when condoms alone are used, although the risk remains low [ 42 ]. One study reported irregular condom use in the first year after HIV diagnosis of 47.0% to 17.5% (p < 0.05) and 49.6% to 17.8% (p < 0.01) for anal sex primary and casual partners, respectively. The rate of irregular condom use remained at approximately 20% after treatment initiation and viral load suppression [ 43 ]. Antiretroviral therapy has been demonstrated to lower the risk of sexual transmission of HIV. Moreover, sexual behavior patterns, particularly the avoidance of practices classified as high-risk, are frequently reported as factors that may influence adherence, treatment outcomes, and viral suppression among people living with HIV [ 44 ]. Study limitations The population of our study is PLWH, a category of patients who has been subject to discrimination and stigma, which contributed to participant attrition and may have affected the representativeness of the sample. Some variables, such as weight, height or even the calculation of body mass index, were not considered. We had to collect data from several health care facilities because of the nonavailability of viral load results despite sampling due to the nonfunctioning of the provincial laboratory and the fact that all samples were sent to Kinshasa or Lubumbashi for analysis. The cohort had an average of nine years on antiretroviral therapy, indicating a population with relatively greater stability and adherence; however, this may restrict the generalizability of findings to newly diagnosed individuals or those with shorter treatment histories. Overall, these limitations highlight the need for future research aimed at reducing attrition, incorporating a broader range of clinical variables, and ensuring more timely access to virological data. CONCLUSION This study of viral load suppression in PLWH on ART highlighted the effectiveness of current treatments in managing HIV and reducing the viral load to undetectable levels. The results indicated that, in many situations, PLWH on ART who reported correct adherence to treatment, consistent condom use, and the absence of casual sexual partners were more likely to achieve viral suppression. While these associations suggest potential benefits for both quality of life and reduced risk of HIV transmission, the cross-sectional and observational design of the study does not allow for causal inferences. In addition, although antiretrovirals have significantly improved HIV management, strengthening patient support strategies, particularly with respect to treatment adherence and compliance education, comorbidity prevention and stigma reduction, remains crucial. A holistic approach that combines medical care, psychosocial support and treatment accessibility is essential to optimize ART outcomes and ensure a healthy, fulfilling life for PLWH. These results highlight the crucial impact of treatment adherence and sexual health practices on viral control. They support the implementation of targeted strategies to strengthen patients' commitment to treatment and reduce risk behaviors. Abbreviations and acronyms AIDS Acquired Immunodeficiency Syndrome ART Anti-Retroviral Therapy HIV Human Immunodeficiency Virus IQR Interquartile range IRR Incidence rate ratio PLWH Person leaving with HIV VL Viral load Declarations Ethics approval and consent to participate N/A Consent for publication All participants provided consent for the publication of the study results, with full respect for confidentiality and anonymity. Competing interests The authors declare that they have no competing interests. Ethical consideration Ethical authorization was granted by the ethics committee of the Official University of Mbujimayi, registered in number 001/2024/CERUOM/NKL. Free and informed consent was used in both French and Tshiluba (the local national language). The ethical regulations outlined in the Declaration of Helsinki were followed throughout the study. The data were stored on a laptop computer with a password-protected and locked cabinet, and only the lead investigator and study supervisor had access to the data. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Conceptualization: DB and GN, Methodology: AM, KNM, PMC and PL, Data curation: DB, BMN and CT, Formal analysis: DB, GN, AM and BMN, Writing – original draft: DB, CT, CKM, Writing – review & editing: DB, AMK, KNM, CKM, PMC, and PL and, Supervision: AMK, PMC, CKM and PL, Validation: All authors, Final approval of the manuscript: All authors Acknowledgement We would like to thank Official University of Mbujimayi, Provincial coordination of the national HIV/AIDS program in East Kasai, and administrators of the hospitals as well as staffs of the hospitals for their genuine cooperation during the data collection processes. Our gratitude also goes to data collectors and supervisors for their hardworking and patience in obtaining the necessary information. Our special thanks also go to participants who generously shared their thoughts and feelings and other commitments Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References UNAIDS. FACT SHEET on Global HIV statistics: ending the AIDS epidemic UNAIDS In.; 2022. Dorward J, Drain PK, Osman F, Sookrajh Y, Pillay M, Moodley P, Garrett N. Short Communication: Early Antiretroviral Therapy Is Associated with Better Viral Suppression and Less HIV Drug Resistance After Implementation of Universal Treatment in South Africa. AIDS Res Hum Retroviruses. 2020;36(4):297–9. Dorward J, Sookrajh Y, Ngobese H, Lessells R, Sayed F, Bulo E, Moodley P, Samsunder N, Lewis L, Tonkin-Crine S, et al. 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Risk Factors Associated with Unsuppressed Viral Load in HIV-1 Infected Patients at the First Antiretroviral Therapy in Morocco. Int J Mycobacteriology. 2019;8(2):113–7. Institut National de Santé Publique de Quebec: Consensus d’experts: charge virale et risque de transmission du VIH. In: Arch Clin Neuropsychol. Quebec: INSPQ. 2014: 1–51. Laxmeshwar C, Acharya S, Das M, Keskar P, Pazare A, Ingole N, Mehta P, Gori P, Mansoor H, Kalon S, et al. Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India. PLoS ONE. 2020;15(5):e0232576. Martin-Blondel G, Saune K, Vu Hai V, Marchou B, Delobel P, Izopet J, Cuzin L, Massip P. Factors associated with a strictly undetectable viral load in HIV-1-infected patients. HIV Med. 2012;13(9):568–73. Hermans LE, Moorhouse M, Carmona S, Grobbee DE, Hofstra LM, Richman DD, Tempelman HA, Venter WDF, Wensing AMJ. Effect of HIV-1 low-level viraemia during antiretroviral therapy on treatment outcomes in WHO-guided South African treatment programmes: a multicentre cohort study. Lancet Infect Dis. 2018;18(2):188–97. Kennedy MC, Kerr TH, Wood E, Shoveller JA, Montaner JSG, Milloy MS. Social and structural factors associated with greater time with a plasma HIV-1 RNA viral load above log10(1500) copies/ml among illicit drug users. AIDS. 2018;32(8):1059–67. Joseph Davey D, Abrahams Z, Feinberg M, Prins M, Serrao C, Medeossi B, Darkoh E. Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa. Int J STD AIDS. 2018;29(6):603–10. Benator DA, Elmi A, Rodriguez MD, Gale HB, Kan VL, Hoffman HJ, Tramazzo S, Hall K, McKnight A, Squires L. True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring. AIDS Behav. 2015;19(4):594–600. Shiferaw MB, Endalamaw D, Hussien M, Agegne M, Amare D, Estifanos F, Temesgen D. Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia. BMC Infect Dis. 2019;19(1):419. Acharya P, Neupane AP, Sigdel B, Ghimire L, Pant MR, Budhathoki A, Poudyal A. Magnitude of Viral Load Suppression and Associated Factors among HIV-positive Patients Receiving Antiretroviral Therapy. J Nepal Health Res Counc. 2023;21(1):159–64. Opoku S, Sakyi SA, Ayisi-Boateng NK, Enimil AK, Senu E, Ansah RO, Aning BD, Ojuang DA, Wekesa DN, Ahmed FO, et al. Factors associated with viral suppression and rebound among adult HIV patients on treatment: a retrospective study in Ghana. AIDS Res Ther. 2022;19(1):21. Diress G, Dagne S, Alemnew B, Adane S, Addisu A. Viral Load Suppression after Enhanced Adherence Counseling and Its Predictors among High Viral Load HIV Seropositive People in North Wollo Zone Public Hospitals, Northeast Ethiopia, 2019: Retrospective Cohort Study. AIDS Res Treat 2020, 2020:8909232. Satre DD, Sarovar V, Leyden W, Hare CB, Catz SL, Bryant KJ, Williams EC, Hojilla JC, Horberg MA, Silverberg MJ. Changes in Days of Unhealthy Alcohol Use and Antiretroviral Therapy Adherence, HIV RNA Levels, and Condomless Sex: A Secondary Analysis of Clinical Trial Data. AIDS Behav. 2020;24(6):1784–92. Myers B, Lombard C, Joska JA, Abdullah F, Naledi T, Lund C, Petersen Williams P, Stein DJ, Sorsdahl KR. Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa. AIDS Behav. 2021;25(11):3758–69. Wynn A, Sileo KM, Schmarje Crockett K, Naigino R, Ediau M, Menzies NA, Kalichman SC, Wanyenze RK, Martin NK, Kiene SM. Associations Between Alcohol Use, Antiretroviral Therapy Use, and Viral Load Suppression Among People Living with HIV in Rural Central Uganda. AIDS Behav. 2024;28(7):2205–15. Rosen JG, Ssekubugu R, Chang LW, Ssempijja V, Galiwango RM, Ssekasanvu J, Ndyanabo A, Kisakye A, Nakigozi G, Rucinski KB, et al. Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viraemia during Universal Test and Treat scale-up in Uganda: a population-based study. J Int AIDS Soc. 2024;27(2):e26200. Bertholet N, Saitz R, Hahn JA, Heeren TC, Emenyonu NI, Freiberg M, Winter MR, Kim TW, Magane KM, Lloyd-Travaglini C, et al. Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV. Alcohol Clin Exp Res (Hoboken). 2023;47(4):704–12. Long JE, Richardson BA, Wanje G, Wilson KS, Shafi J, Mandaliya K, Simoni JM, Kinuthia J, Jaoko W, McClelland RS. Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy. PLoS ONE. 2020;15(11):e0242817. LeMessurier J, Traversy G, Varsaneux O, Weekes M, Avey MT, Niragira O, Gervais R, Guyatt G, Rodin R. Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review. CMAJ. 2018;190(46):E1350–60. Poon CM, Wong NS, Kwan TH, Wong HTH, Chan KCW, Lee SS. Changes of sexual risk behaviors and sexual connections among HIV-positive men who have sex with men along their HIV care continuum. PLoS ONE. 2018;13(12):e0209008. Chen SC, Wang ST, Chen KT, Yan TR, Tang LH, Lin CC, Yen SF. Analysis of the influence of therapy and viral suppression on high-risk sexual behaviour and sexually transmitted infections among patients infected with human immunodeficiency virus in Taiwan. Clin Microbiol Infect. 2006;12(7):660–5. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9330574","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618047430,"identity":"75ce47c8-01d9-4de3-bbd0-daeb9474755e","order_by":0,"name":"Désiré 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Congo","correspondingAuthor":false,"prefix":"","firstName":"Philippe","middleName":"","lastName":"Mulenga-Cilundika","suffix":""},{"id":618047437,"identity":"2a1104b9-382c-49cf-831b-ae644230d60a","order_by":7,"name":"André Mutombo","email":"","orcid":"","institution":"Department of Pediatrics, Faculty of Medicine, Mbujimayi Official University, Mbujimayi, Democratic Republic of Congo","correspondingAuthor":false,"prefix":"","firstName":"André","middleName":"","lastName":"Mutombo","suffix":""},{"id":618047439,"identity":"8af5cef1-c2db-4821-ad83-84d97ad98acd","order_by":8,"name":"Pascal Lutumba","email":"","orcid":"","institution":"Department of Tropical Medicine and Infectious Diseases, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo","correspondingAuthor":false,"prefix":"","firstName":"Pascal","middleName":"","lastName":"Lutumba","suffix":""}],"badges":[],"createdAt":"2026-04-06 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10:30:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1506464,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9330574/v1/5ecb3884-b347-4491-a51d-e4491cabe1ed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlates of viral load suppression among people living with HIV on antiretroviral treatment in Mbujimayi, Democratic Republic of Congo: a cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eAcquired immunodeficiency syndrome (AIDS) remains a major global public health challenge and has been one of the leading causes of mortality worldwide since the onset of the epidemic. Between its emergence and 2021, approximately 40.1\u0026nbsp;million people died from AIDS-related illnesses [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. With improved access to prevention, diagnosis, treatment, and care, infection with the human immunodeficiency virus (HIV) has increasingly been managed as a chronic condition, allowing many individuals to live longer and healthier lives.\u003c/p\u003e \u003cp\u003eThe advent of antiretroviral therapy (ART) has transformed the trajectory of the epidemic, offering hope for better control. However, access to ART remains problematic in many low- and middle-income countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In these settings, ART is predominantly delivered through primary care facilities, where laboratory capacity for viral load monitoring is limited, health systems often lack the ability to act on viral load results, and evidence-based interventions to strengthen adherence are scarce [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the WHO and CDC, sustained adherence to ART is the key determinant of viral load suppression and reduced transmission risk. Yet, long-term adherence in resource-limited settings is hindered by multiple patient- and program-related barriers, including poverty, food insecurity, alcohol and tobacco use, poor quality of life, sexual behaviors, forgetfulness, limited knowledge, treatment interruptions, distance to health facilities, and the cost of care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSuboptimal adherence or treatment interruptions can lead to viral rebound, undermining the benefits of long-term ART [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Conversely, individuals who achieve viral suppression experience stronger immune recovery, improved clinical outcomes, and reduced mortality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Moreover, maintaining an undetectable viral load eliminates the risk of sexual transmission to HIV-negative partners, a principle captured in the Undetectable or Untransmittable campaign [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these advances, a proportion of patients continue to struggle with achieving or maintaining viral suppression [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In the Democratic Republic of Congo (DRC), studies conducted in Kinshasa and Haut Katanga reported viral suppression rates ranging from 62% to 92.5%, with undetectable viral load levels between 53% and 56.4% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to national estimates from the HIV/AIDS Control Program (PNLS/PNMLS), only 19% of PLWH had a suppressed viral load, far below the UNAIDS 95-95-95 targets [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Social determinants of health\u0026mdash;including depression, adverse events, self-efficacy, and social support\u0026mdash;also play critical roles in adherence and viral suppression [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Poor engagement in care, particularly during the early stages of treatment, is strongly associated with inadequate adherence [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn East Kasai Province, where Mbujimayi is located, monitoring ART effectiveness remains particularly challenging. Provincial laboratories lack the capacity to perform viral load testing, limiting systematic surveillance and hindering timely clinical interventions such as adherence counseling [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn accordance with the national policy for integrated HIV/AIDS care in DRC and WHO recommendations for viral load monitoring among PLWH on ART specifically, an initial test six months after treatment initiation, followed by a second test at 12 months (six months after the first). After two consecutive undetectable results, RNA testing is performed annually [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, significant gaps persist in resource-limited contexts, particularly in the East Kasai province.\u003c/p\u003e \u003cp\u003eThis study aimed to identify the factors associated with viral load suppression among people living with HIV receiving highly active antiretroviral therapy (HAART) in Mbujimayi, Democratic Republic of Congo. By clarifying these determinants, the study seeks to contribute to improved patient follow-up and to reducing HIV-related morbidity and mortality.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eWe conducted a cross-sectional study to document the factors that can influence viral load suppression of PLWH to ART in the Mbujimayi city, the capital of East Kasai Province in the Democratic Republic of the Congo. Mbujimayi town comprises 10 of East Kasai Province's 19 health zones. We conducted our study at 10 healthcare facilities in Mbujimayi (Hospital Bonzola Hospital, Dipumba Hospital currently Clinique Universitaire de Mbujimayi, Presbyterian Hospital, Kansele Hospital, Kayembe Hospital, Saint Franciscans Hospital, Bena Cibuabua Center, Camp Nsele Center and Centre Nyongolo Center), which care for PLWH and have viral load results.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe target population of the study was HIV-positive people on ART attending HIV/AIDS treatment and diagnosis centers in the city of Mbujimayi. Given the constraints related to the achievement of the viral load (VL), the accessible population on which we worked was composed of PLWH attending the targeted hospitals and organizing the VL between the study period.\u003c/p\u003e\n\u003ch3\u003eStudy eligibility criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for the study participants were individuals who met the following conditions: all HIV patients on antiretroviral treatment who received a viral load in the selected facilities during the study period.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNon-inclusion criteria\u003c/h3\u003e\n\u003cp\u003eAll PLWH were not receiving antiretroviral therapy (ART) at the study period; patients who did not undergo a viral load test during the study period, patients followed up in health facilities not selected for the study and individuals with incomplete or missing data regarding HIV status, ART regimen, or viral load results.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample size\u003c/h2\u003e \u003cp\u003eWe estimated the sample size using the Fleiss formula for two proportions [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]:\u003c/p\u003e \u003c/div\u003e\n\u003cdiv class=\"Heading\"\u003eN =\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\frac{\\text{[}{\\text{Z}}_{\\text{\u0026alpha;}}\\sqrt{\\text{p}\\left(\\text{1-}\\text{p}\\right)\\text{(}\\frac{\\text{1}}{{\\text{q}}_{\\text{1}}}\\text{+}\\frac{\\text{1}}{{\\text{q}}_{\\text{2}}}}\\text{)\\:+\\:}{\\text{Z}}_{\\text{\u0026beta;}}\\sqrt{{\\text{p}}_{\\text{1}}\\left(\\text{1-}\\text{P}\\text{1}\\right)\\frac{\\text{1}}{{\\text{q}}_{\\text{1}}}\\text{+}{\\text{p}}_{\\text{2}}\\left(\\text{1-}\\text{P}\\text{2}\\right)}\\frac{\\text{1}}{{\\text{q}}_{\\text{2}}}\\text{}{\\text{]}}^{\\text{2}}}{{\\text{(}\\text{P}\\text{2-}\\text{P}\\text{1)}}^{\\text{2}}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/div\u003e \u003cp\u003ewhere p1 is the proportion of patients with a suppressed viral load, 0.19 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and p2 is the expected proportion of no suppressed patients in the study (35%). We set the power at 80% (Zβ\u0026thinsp;=\u0026thinsp;0.84) and the confidence interval at 95% (Zα\u0026thinsp;=\u0026thinsp;1.96) with a no suppressed/suppressed ratio of 2:1. Consequently, the initial estimated sample size was approximately 561 PLWH on ART, including 187 suppressed PLWH and 374 no suppressed PLWH.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003e Investigators were recruited in Mbujimayi based on their availability, educational background, and adherence to the principal investigator\u0026rsquo;s guidelines. Prior to data collection, they underwent comprehensive training on the use of the data collection tool. The training covered the study context, specific objectives, case definitions, and operational acronyms. Additionally, ethical and cultural considerations, appropriate dress code, and professional conduct during fieldwork were emphasized. Potential factors that could influence data quality were also discussed to ensure methodological rigor.\u003c/p\u003e \u003cp\u003eWe used a data collection grid in PLWH files. Data collection took place from November 7, 2022, to January 9, 2023. Pretesting of the data collection tool (questionnaire) was carried out in two healthcare facilities (Muya Hospital and Christ-Roi Hospital) before the actual data collection was launched in the selected care facilities. Final modifications were made to the data collection tool immediately after the pretest, and enumerators were reassessed for suitability; unsuitable enumerators were automatically excluded from the study. Given that our main source of data was the records of PLWH on targeted ART in health facilities, and supplemented by interviewing patients about missing elements in the record, we were able to select PLWH who had achieved a viral load and whose result was available, respecting the ratio of 1 suppressed for 2 not suppressed. Once selected, cases were approached by investigators or research assistants at the earliest opportunity.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables and measurements\u003c/h2\u003e \u003cp\u003eThe primary objective of this study was to identify predictors of viral load suppression, defined as a viral load of \u0026le;\u0026thinsp;1000 RNA copies per milliliter of blood. This criterion aligns with the World Health Organization (WHO) guidelines and the standard measurement used in the Democratic Republic of Congo (DRC) [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. To ensure consistency and accuracy, the most recent viral load result was used for analysis; thus, a single RNA measurement served to define viral load suppression.\u003c/p\u003e \u003cp\u003eIn addition to viral load suppression, the analysis considered several explanatory variables, including sociodemographic, economic, and HIV-related clinical factors. Sociodemographic variables included sex, age, geographic origin, main activities (occupation), socioeconomic status, education, marital status, household size, presence of a stable and/or occasional partner, and alcohol and tobacco use. Clinical variables included duration on ART, WHO clinical stage, ART regimen, tuberculosis co-infection, condom use, and ART adherence.\u003c/p\u003e \u003cp\u003eART adherence was defined as correct and consistent intake of prescribed antiretroviral drugs. Adherence was assessed using patient medical records and confirmed through self-report during interviews. Participants were classified as adherent (\u0026ge;\u0026thinsp;95% of doses taken) or non-adherent [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The ART regimen used by all patients included in this study consists of a combination of two nucleoside reverse transcriptase inhibitors (tenofovir and lamivudine) and one integrase inhibitor (dolutegravir), in accordance with the integrated HIV management guidelines in the DRC.\u003c/p\u003e \u003cp\u003eThese variables were selected based on their epidemiological relevance and documented association with viral load suppression in the scientific literature. They were categorized according to international standards to ensure comparability and analytical robustness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData management\u003c/h2\u003e \u003cp\u003eThe data were initially received in a Microsoft Excel format and subsequently imported into Stata 17 for further processing and analysis. In Stata, variables were meticulously constructed and defined in accordance with the specified measurements and parameters of the study.\u003c/p\u003e \u003cp\u003eTo ensure the integrity and reliability of the dataset, a rigorous data cleaning process was undertaken. This process commenced with the execution of descriptive statistical analyses to identify any anomalies, errors, inconsistencies, or missing values within the dataset. Observations with missing data points pertaining to the outcome variable were systematically excluded from subsequent analyses. This step was undertaken to maintain the robustness and validity of the analytical procedures employed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using Stata statistical software, version 17. Descriptive analysis was conducted; wherein continuous variables such as age, ART duration and household size were presented as medians with interquartile range (IQR). Categorical variables were summarized as frequencies and percentages with their 95% IC. Bivariable analysis was conducted using the chi-square test for all dichotomized variables. Factors that were significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.2, such as profession, provenance, casual sexual partner, condom use, smoking, alcoholism, pulmonary tuberculosis, clinical stage, ART duration and adherence, were further evaluated in the multivariable binomial logistic regression model to adjust for measured confounding factors and predict the variability of the response as a function of the explanatory variable. Adjusted odds ratios (AOR) was estimated with their 95% CI to measure the strength of the associations between the independent variables considered and the suppression of the viral load. All variables with a p\u0026thinsp;\u0026le;\u0026thinsp;0.05 were considered statistically significant and retained in the final model.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e \u003cb\u003eCharacteristics of study participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis table shows that the median age of PLWH on ART is 49 years (IQR: 19). The median household size is 5 persons (IQR: 4), and the median duration on ART is 9 years (IQR: 7). Participants were 66.31% female, 48.48% married, and 81.11% had a secondary education level. Employment was reported by 52.58%, 89.48% resided in the urban area of Mbujimayi, and 93.94% had low socioeconomic status. A stable sexual partner was reported by 48.66% and a casual sexual partner by 15.69%. Smoking was observed in 14.08% and alcohol consumption in 8.02%. Pulmonary tuberculosis was present in 57.40%, and 67.56% were classified as WHO stage III. Condom use was reported by 67.91%. All participants were on the TDF/3TC/DTG (TLD) regimen, with good adherence achieved in 86.45% (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and economic characteristics and clinical and therapeutic variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;561\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% [95%CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian (Q1 \u0026ndash; Q3)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (39\u0026ndash;57) years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[15\u0026ndash;49]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.76 [48.63\u0026ndash;56.86]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeyond 49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.24 [43.14\u0026ndash;51.37]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold size (person)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[0\u0026ndash;5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.43 [56.32\u0026ndash;64.39]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeyond 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.57 [35.61\u0026ndash;43.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration ART (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (6\u0026ndash;13) years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[0\u0026ndash;9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.94 |48.80\u0026ndash;54.04]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[Beyond 9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.06 [42.96\u0026ndash;51.20]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eViral load (copy/ml)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[\u0026le;\u0026thinsp;40]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.23 [25.62\u0026ndash;33.13]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[41\u0026ndash;1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.10 [2.75\u0026ndash;6.08]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[Beyond 1000]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.67 [62.66\u0026ndash;70.44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.31 [62.30\u0026ndash;70.10]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.69 [29.90\u0026ndash;37.70]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.33 [12.59\u0026ndash;18.55]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.48 [44.37\u0026ndash;52.62]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.63 [24.09\u0026ndash;31.47]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.56 [6.51\u0026ndash;11.16]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUneducated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.32 [1.36\u0026ndash;3.92]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.52 [8.24\u0026ndash;13.33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.11 [77.66\u0026ndash;84.13]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher and University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.06 [4.37\u0026ndash;8.35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain activities (occupation)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.58 [48.45\u0026ndash;56.69]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonemployees \u0026amp; others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.42 [43.31\u0026ndash;51.55]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89.48 [86.67\u0026ndash;91.76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.52 [8.24\u0026ndash;13.33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocioeconomic status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93.94 [91.65\u0026ndash;95.63]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.06 [4.37\u0026ndash;8.35]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStable sexual partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.66 [44.55\u0026ndash;52.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.34 [47.21\u0026ndash;55.45]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCasual sexual partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.69 [12.91\u0026ndash;18.93]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84.31 [81.07\u0026ndash;87.09]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.08 [11.45\u0026ndash;17.21]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85.92 [82.79\u0026ndash;88.55]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.02 [6.05\u0026ndash;10.57]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.98 [89.43\u0026ndash;93.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary tuberculosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.40 |53.27\u0026ndash;61.43]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.60 [38.57\u0026ndash;46.73]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWHO disease stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.96 [1.10\u0026ndash;3.48]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.72 [15.71\u0026ndash;22.15]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.56 [63.58\u0026ndash;71.30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.76 [9.35\u0026ndash;14.69]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCondoms use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.91 [63.94\u0026ndash;71.64]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.09 [28.36\u0026ndash;36.06]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.45 [83.37\u0026ndash;89.04]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.55 [10.96\u0026ndash;16.63]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eViral load suppression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.33 [29.56\u0026ndash;37.34]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.67 [62.66\u0026ndash;70.44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePrediction factors with viral load suppression among people living with HIV.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe bivariate analysis revealed a statistically significant relationship between nonexistence of casual sexual partners (p\u0026thinsp;=\u0026thinsp;0.005), condom use (p\u0026thinsp;=\u0026thinsp;0.0011), pulmonary tuberculosis (p\u0026thinsp;=\u0026thinsp;0.013), clinical stage (p\u0026thinsp;=\u0026thinsp;0.32), duration of ART (p\u0026thinsp;=\u0026thinsp;0.004) and adherence (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with viral load suppression (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In the Multivariate analysis with binomial logistic regression model, the absence of a casual sexual partner (AOR: 2.179 [95% CI: 1.211\u0026ndash;3.888], p\u0026thinsp;=\u0026thinsp;0.008), condom use (AOR: 1.764 [95% CI: 1.144\u0026ndash;2.721], p\u0026thinsp;=\u0026thinsp;0.010), duration of ART beyond 9 years (AOR: 1.590 [1.086\u0026ndash;2.328], p\u0026thinsp;=\u0026thinsp;0.017), and adherence (AOR: 11.743 [4.153\u0026ndash;33.204], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significant factors associated with viral load suppression in PLWH on ART. Alcohol abstinence was also a protective factor (AOR: 0.486 [0.240\u0026ndash;0.985], p\u0026thinsp;=\u0026thinsp;0.045). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrediction factors (bivariate analysis and multivariate analysis with binomial logistic regression)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eViral load suppression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;187)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo (n\u0026thinsp;=\u0026thinsp;374)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCOR [95%CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR [95%CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[15\u0026ndash;49]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (31.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202 (68.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.861 [0.606\u0026ndash;1.223]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeyond 49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93 (35.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e172 (64.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexe\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118 (31.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e254 (68.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.869 [0.559\u0026ndash;1.167]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (36.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120 (63.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone (single, widowed, divorced)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97 (33.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (66.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.022 [0.719\u0026ndash;1.452]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90 (33.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182 (66.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInstruction\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUneducated \u0026amp; Primary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (29.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (70.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.801 [0.466\u0026ndash;1.377]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary \u0026amp; High/University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166 (33.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e323 (66.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold size (person)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[0\u0026ndash;5]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110 (32.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e229 (67.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.905 [0.632\u0026ndash;1.294]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeyond 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (34.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145 (65.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109 (36.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186 (63.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.412 [0.991\u0026ndash;2.013]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.280 [0.808\u0026ndash;1.915]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonemployees \u0026amp; others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78 (29.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e188 (70.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of residence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174 (34.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e328 (65.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.877 [0.987\u0026ndash;3.569]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.412 [0.712\u0026ndash;2.801]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (22.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (77.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocioeconomic status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177 (33.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e350 (66.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.214 [0.568\u0026ndash;2.594]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (29.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (70.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStable sexual partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182 (66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00 [0.704\u0026ndash;1.421]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e192 (66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCasual sexual partner\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (20.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (79.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169 (35.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e304 (64.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.162 [1.246\u0026ndash;3.751]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.179 [1.221\u0026ndash;3.888]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCondoms use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e144 (37.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e237 (62.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.936 [1.297\u0026ndash;2.889]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.764 [1.144\u0026ndash;2.721]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (23.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137 (76.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32 (40.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47 (59.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e155 (32.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327 (67.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.696 [0.427\u0026ndash;1.134]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.895 [0.514\u0026ndash;1.556]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.694\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (46.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (53.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166 (32.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e350 (67.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.542 [0.293\u0026ndash;1.002]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.486 [0.240\u0026ndash;0.985]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePulmonary tuberculosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e121 (37.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201 (62.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.578 [1.098\u0026ndash;2.267]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.413 [0.947\u0026ndash;2.107]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e66 (27.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e173 (72.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWHO disease stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 1 \u0026amp; 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage 3 \u0026amp; 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e158 (35.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e287 (64.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.652 [1.040\u0026ndash;2.624]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.578 [0.956\u0026ndash;2.605]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART duration (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e[0\u0026ndash;9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83 (27.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214 (72.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBeyond 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104 (39.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160 (60.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.676 [1.177\u0026ndash;2.387]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.590 [1.086\u0026ndash;2.328]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eART adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183 (37.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e302 (62.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.907 [3.920\u0026ndash;30.352]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11.743 [4.153\u0026ndash;33.204]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72 (94.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eROC Curve\u003c/h2\u003e \u003cp\u003eThe area under the curve (AUC) values indicated that the ability to predict viral load suppression among PLWH was approximately 72.5% (AUC: 0.725 [95% CI: 0.682\u0026ndash;0.769], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study highlights the following: the factors associated with viral load suppression in our study were adherence, the absence of an occasional sexual partner and condoms use.\u003c/p\u003e \u003cp\u003eIn our work, we found that therapeutic adherence was 86.45%, whereas nonadherence was 14.55%. Abdullahi \u003cem\u003eet al.\u003c/em\u003e (2020), in their 2020 work in Ethiopia, reported that 36.1% of participants had low adherence and that poor adherence was associated with a 10-fold increased risk of an unsuppressed viral load [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The difference between the two studies may be explained by variations in treatment regimens and patient follow-up. In our setting, simplified therapeutic strategies and consistent monitoring likely contributed to better adherence. These findings reinforce the importance of optimized treatment and strengthened follow-up to improve compliance and reduce treatment failure. Several studies have highlighted considerable variability in ART adherence, for instance, Ladak \u003cem\u003eet al.\u003c/em\u003e (2019) reported adherence rates exceeding 95% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In contrast, Touzard Romo \u003cem\u003eet al.\u003c/em\u003e (2014) documented fluctuations between 2003 and 2010, with adherence ranging from 67% to 86% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Moreover, Kalichman \u003cem\u003eet al.\u003c/em\u003e (2014), found that 47% of patients did not adhere properly to ART, and identified alcohol consumption, lack of medication and certain social situations as contributing factors [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn previous studies on the determinants of suppression or no suppression of the viral load, the authors consistently reported increased risks of no suppression in people with poor adherence to therapy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A high viral load is observed in people with poor adherence because an optimal drug concentration is needed to control viral replication. It has been reported that 95% or more adhesion is required for sustained viral suppression [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eViral load suppression among PLWH on ART is influenced by several factors, including coinfections, specific ART regimen, suboptimal adherence, drug resistance, and the stage of infection [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Consistent adherence is critical to achieving and sustaining suppression. Although, alcohol consumption has often been studied in relation to adherence, its direct effect on viral suppression has received less attention. Evidence from India showed that improved adherence was the main determinant of suppression, with 88% of PLWH achieving viral load suppression despite 48% initially experiencing clinical or immunological failure [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Nevertheless, the emergence of ART-resistant strains demonstrates that even patients with good adherence may fail to achieve suppression, as resistance frequently results from a history of poor adherence [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our series, we found that adherence was significantly associated with viral load suppression (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Good adherence was associated with approximately a seven-fold greater likelihood of achieving viral load suppression (IRR 6.956 [95% CI: 2.579\u0026ndash;18.763). This result highlights interest and reinforces the need to improve adherence and therapeutic compliance at a high level, more than 90%, to ensure the sustained and lasting effectiveness of the ART for the suppression of the viral load.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that good adherence, duration of ART, and disclosure of status are factors in viral load suppression [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A study conducted in 2022 in Kinshasa and Upper Katanga in the DRC before and after COVID-19 by Shah \u003cem\u003eet al\u003c/em\u003e. revealed that viral load suppression was associated with the timing of ART initiation (AOR: 2.50), female sex (AOR: 1.23), rural residence (AOR: 1.83), and the timing of the last visit (AOR: 1.50) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, homelessness and lack of moral support [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], male sex, initiation of ART\u0026thinsp;\u0026lt;\u0026thinsp;15 years, treatment for tuberculosis, duration of one year and more than 10 years under ART [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], drug and alcohol use [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], poor adherence to therapy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and nevirapine-based treatment [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] are associated with no suppression of the viral load and/or rebound.\u003c/p\u003e \u003cp\u003eIn East Kasai Province in the DRC, 19% of HIV patients on ART had access to a viral load test [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This low rate of access is explained by the difficulty in supplying inputs to the provincial laboratory, thus having a negative impact on the follow-up of patients. Currently, many more than 1000 unanalyzed samples are at the National Institute for Biomedical Research, possibly because either the influx of samples or the samples are not taken in the standards and are unanalyzable. We believe that if the provincial laboratory was supplied with inputs to achieve a viral load, PLWH would be monitored without any problems, which would lead to better monitoring of patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe absence and/or absence of an occasional sexual partner was significantly associated with viral load suppression (AOR: 2,179 [95% CI: 1,221\u0026ndash;3,888], p\u0026thinsp;=\u0026thinsp;0.008. Although the mechanisms underlying this situation were not explored in our study, it is possible that individuals with greater adherence to ART may also be more selective in their sexual partnerships, thereby contributing to improved adherence and more consistent follow-up. However, this hypothesis cannot be confirmed with the current analysis. This statistical association highlights the need for further research to clarify the influence of relational contexts on adherence and viral suppression among PLWH.\u003c/p\u003e \u003cp\u003eWe also found that condom use (AOR: 1,764 [95% CI: 1,144\u0026ndash;2,721]) and the duration of treatment beyond 9 years (AOR: 1,590 [95% CI: 1,086\u0026thinsp;\u0026minus;\u0026thinsp;2,328]) were also factors in viral load suppression in PLWH. In contrast, alcohol was a protective factor (AOR: 0.486 [95% CI: 0.240\u0026ndash;0.985]). Some authors found factors in their study that predicted viral load suppression. These factors include a longer duration of antiretroviral treatment (\u0026gt;\u0026thinsp;3 years) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], WHO stage I diagnosis, good adherence to antiretroviral therapy, nevirapine-based treatment and increasing duration of treatment [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]; women and people with higher levels of education [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]; and reduced alcohol consumption [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In contrast, our study identified therapeutic adherence, condom use, and the absence of casual sexual partners as the only factors associated with viral suppression. This variation may reflect the particular characteristics of the study population and the limitations inherent in a cross-sectional design, which restricts the ability to capture additional clinical or socio-demographic predictors.\u003c/p\u003e \u003cp\u003eOn the other hand, the probability of viral load suppression was lower in people who had been on antiretroviral therapy for 36 to 59 months [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Occasional and frequent heavy drinking is associated with viral no suppression [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The authors also showed that the association was not statistically significant when restricted to people on antiretroviral treatment, suggesting that the relationship between alcohol consumption and viral suppression is explained by the use of antiretroviral treatment [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]; young people aged 15\u0026ndash;29 years, among men, people reporting irregular condom use with nonmarital/casual partners versus people with marital/permanent partners only [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Other authors have reported a no association between abusive, hazardous, harmful and dependent alcohol consumption and HIV viral suppression [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA meta-analysis revealed that on the basis of scientific evidence and high-quality data, the risk of sexual transmission of HIV is negligible when an HIV-positive sexual partner is on antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/ml, measured every 4\u0026ndash;6 months. Sexual transmission of HIV occurs when the viral load is above 200 copies/ml with antiretroviral therapy or when condoms alone are used, although the risk remains low [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. One study reported irregular condom use in the first year after HIV diagnosis of 47.0% to 17.5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and 49.6% to 17.8% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) for anal sex primary and casual partners, respectively. The rate of irregular condom use remained at approximately 20% after treatment initiation and viral load suppression [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAntiretroviral therapy has been demonstrated to lower the risk of sexual transmission of HIV. Moreover, sexual behavior patterns, particularly the avoidance of practices classified as high-risk, are frequently reported as factors that may influence adherence, treatment outcomes, and viral suppression among people living with HIV [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003e The population of our study is PLWH, a category of patients who has been subject to discrimination and stigma, which contributed to participant attrition and may have affected the representativeness of the sample. Some variables, such as weight, height or even the calculation of body mass index, were not considered. We had to collect data from several health care facilities because of the nonavailability of viral load results despite sampling due to the nonfunctioning of the provincial laboratory and the fact that all samples were sent to Kinshasa or Lubumbashi for analysis.\u003c/p\u003e \u003cp\u003eThe cohort had an average of nine years on antiretroviral therapy, indicating a population with relatively greater stability and adherence; however, this may restrict the generalizability of findings to newly diagnosed individuals or those with shorter treatment histories. Overall, these limitations highlight the need for future research aimed at reducing attrition, incorporating a broader range of clinical variables, and ensuring more timely access to virological data.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study of viral load suppression in PLWH on ART highlighted the effectiveness of current treatments in managing HIV and reducing the viral load to undetectable levels. The results indicated that, in many situations, PLWH on ART who reported correct adherence to treatment, consistent condom use, and the absence of casual sexual partners were more likely to achieve viral suppression. While these associations suggest potential benefits for both quality of life and reduced risk of HIV transmission, the cross-sectional and observational design of the study does not allow for causal inferences. In addition, although antiretrovirals have significantly improved HIV management, strengthening patient support strategies, particularly with respect to treatment adherence and compliance education, comorbidity prevention and stigma reduction, remains crucial. A holistic approach that combines medical care, psychosocial support and treatment accessibility is essential to optimize ART outcomes and ensure a healthy, fulfilling life for PLWH.\u003c/p\u003e \u003cp\u003eThese results highlight the crucial impact of treatment adherence and sexual health practices on viral control. They support the implementation of targeted strategies to strengthen patients' commitment to treatment and reduce risk behaviors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv id=\"AGS1\" class=\"AbbreviationGroupSection\"\u003e \u003cdiv class=\"Heading\"\u003eand acronyms\u003c/div\u003e \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAIDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAcquired Immunodeficiency Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eART\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnti-Retroviral Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman Immunodeficiency Virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIncidence rate ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLWH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePerson leaving with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eViral load\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eAll participants provided consent for the publication of the study results, with full respect for confidentiality and anonymity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e Ethical authorization was granted by the ethics committee of the Official University of Mbujimayi, registered in number 001/2024/CERUOM/NKL. Free and informed consent was used in both French and Tshiluba (the local national language). The ethical regulations outlined in the Declaration of Helsinki were followed throughout the study. The data were stored on a laptop computer with a password-protected and locked cabinet, and only the lead investigator and study supervisor had access to the data.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: DB and GN, Methodology: AM, KNM, PMC and PL, Data curation: DB, BMN and CT, Formal analysis: DB, GN, AM and BMN, Writing \u0026ndash; original draft: DB, CT, CKM, Writing \u0026ndash; review \u0026amp; editing: DB, AMK, KNM, CKM, PMC, and PL and, Supervision: AMK, PMC, CKM and PL, Validation: All authors, Final approval of the manuscript: All authors\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Official University of Mbujimayi, Provincial coordination of the national HIV/AIDS program in East Kasai, and administrators of the hospitals as well as staffs of the hospitals for their genuine cooperation during the data collection processes. Our gratitude also goes to data collectors and supervisors for their hardworking and patience in obtaining the necessary information. Our special thanks also go to participants who generously shared their thoughts and feelings and other commitments\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUNAIDS. FACT SHEET on Global HIV statistics: ending the AIDS epidemic UNAIDS In.; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorward J, Drain PK, Osman F, Sookrajh Y, Pillay M, Moodley P, Garrett N. Short Communication: Early Antiretroviral Therapy Is Associated with Better Viral Suppression and Less HIV Drug Resistance After Implementation of Universal Treatment in South Africa. AIDS Res Hum Retroviruses. 2020;36(4):297\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorward J, Sookrajh Y, Ngobese H, Lessells R, Sayed F, Bulo E, Moodley P, Samsunder N, Lewis L, Tonkin-Crine S, et al. Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study. BMJ Open. 2021;11(2):e045373.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah GH, Maluantesa L, Etheredge GD, Waterfield KC, Ikhile O, Beni R, Engetele E, Mulenga A. HIV Viral Suppression among People Living with HIV on Antiretroviral Therapy in Haut-Katanga and Kinshasa Provinces of Democratic Republic of Congo. Healthc (Basel) 2021, 10(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eByrd KK, Hou JG, Bush T, Hazen R, Kirkham H, Delpino A, Weidle PJ, Shankle MD, Camp NM, Suzuki S, et al. 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Clin Microbiol Infect. 2006;12(7):660\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Suppression, Viral load, PLWH, ART, Mbujimayi","lastPublishedDoi":"10.21203/rs.3.rs-9330574/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9330574/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eContext\u003c/h2\u003e \u003cp\u003eAcquired immunodeficiency syndrome (AIDS) remains a major global public health concern and one of the leading causes of mortality worldwide. Lifelong antiretroviral therapy (ART) enables viral load suppression or undetectability, reducing the risk of opportunistic infections and improving survival. However, some individuals fail to achieve viral suppression, and understanding the associated factors is critical. This study aimed to identify key determinants of successful viral suppression among people living with HIV (PLWH) on ART.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in Mbujimayi, Democratic Republic of Congo, involving 561 PLWH from ten healthcare facilities with available viral load results. Data on ART adherence, sexual behavior, and sociodemographic characteristics were collected. Viral load served as the primary outcome. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in bivariate analysis were included in a multivariable modified binomial logistic regression model to adjust for confounders. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants had a median age of 49 years (IQR: 18) and a median ART duration of 9 years (IQR: 7); 66.31% were female, and 67.56% were in WHO clinical stage 3. Condom use was reported by 67.91%, while 84.3% had no casual sexual partners; 91.78% abstained from alcohol, and 86.45% adhered to ART. Multivariable analysis identified ART adherence (AOR 11.743 [95% CI: 4.153\u0026ndash;33.204], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), absence of casual sexual partners (AOR: 2.179 [95% CI: 1.221\u0026ndash;3.888], p\u0026thinsp;=\u0026thinsp;0,008 ), and condom use AOR: 1.764 [95% CI: 1.144\u0026ndash;2.721], p\u0026thinsp;=\u0026thinsp;0.010), and ART duration (AOR: 1.590 [1.086\u0026ndash;2.328], p\u0026thinsp;=\u0026thinsp;0.045) as significant predictors of viral suppression. However, no alcohol consumption was a protective factor (AOR: 0.486 [95% CI: 0.240\u0026ndash;0.985]).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eStrict ART adherence and stable sexual behaviors (absence of casual sexual partners, condom use) were associated with viral suppression. Strengthening health education and psychosocial support programs to promote adherence and safe sexual practices could improve treatment outcomes. These findings provide evidence to guide public health strategies for HIV management in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Correlates of viral load suppression among people living with HIV on antiretroviral treatment in Mbujimayi, Democratic Republic of Congo: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 16:51:53","doi":"10.21203/rs.3.rs-9330574/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-15T10:53:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-08T14:33:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T14:33:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-04-06T06:29:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c052cd0d-5779-4270-bc10-0574a68e2439","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T12:06:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 16:51:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9330574","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9330574","identity":"rs-9330574","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}