Factors associated with Virological non-suppression among adult PLHIV after receiving Intensive Adherence Counseling at Taso Mbale, Eastern Uganda: A Cross-sectional Study

Factors associated with Virological non-suppression among adult PLHIV after receiving Intensive Adherence Counseling at Taso Mbale, Eastern Uganda: 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 Factors associated with Virological non-suppression among adult PLHIV after receiving Intensive Adherence Counseling at Taso Mbale, Eastern Uganda: A Cross-sectional Study Alice Apio, David Jonah Soita, JP Masaba, JKB Matovu, David Mukunya, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3975082/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: According to the Joint United Nations Program (JUNP) on HIV/AIDS through the ambitious 95-95-95 target, 95% of people living with HIV (PLHIV) on antiretroviral treatment (ART) should be virally suppressed. Viral load (VL) non-suppression has been found to be associated with ART adherence, and intensive adherence counseling (IAC) has been shown to lead to VL re-suppression by over 70% in PLHIV on ART. Although Uganda has employed the IAC intervention program since 2015, there is paucity of research data on HIV viral load non-suppression after IAC. Methodology: This was a Cross-sectional study, conducted in TASO Mbale. Data were abstracted for all clients with non-suppressed viral load between Jan 2018 to August 2021 from the TASO Mbale program database and various parameters were considered. These parameters included the IACs done, the repeat VL done, presence of an opportunistic infection, sex, age, and the current regimen. A client was considered to have a non-virological status if there were >1000 copies of CD4 cells. The clients were followed for a maximum period of 43 months. A total of 13428 person months was observed for different periods. The data were then analyzed using statistical software Stata version 14. Bivariate analysis was done for all covariates. Hazard ratios (HRs) were estimated as a degree of association between viral non-suppression and client features, via a Cox proportional hazards regression. Results: A total of 442 PLHIV after IAC were enrolled, of whom 60 (13.6%) had VL non suppression following IAC. The overall rate of VL non-suppression was 4.47 (3.41-5.75) per 1000 person-months (PM) of observation after IAC. ART regimen was statistically significant with viral load suppression especially DTG-3TC-LPV/r based regimen had (AHR=5.78, 95%CI, 1.137-29.384, p=0.034). Poor adherence level to ART had significant contribution to viral load non-suppression (AHR=4.88, 95%CI: 1. 607-14.836, p=0.005). Conclusion: Virological non-suppression after IAC was found at 13.6% and associated with patients’ poor adherence level. Viral load suppression was associated with DTG-3TC-LPV/r and AZT-3TC-LPV/r based regimens. The findings lend a huge boost towards the third UNAIDS target of 95%. Virological non-suppression Intensive Adherence Counseling adult PLHIV facotors Figures Figure 1 Figure 2 1. Introduction According to UNAIDS, 95% of PLHIV on ART should be virally suppressed as was ambitiously set through United Nations’ 95-95-95 target[1] fast tracking the sustainable development goal to end the HIV epidemic by 2030[2, 3]. Globally, in 2020, out of 37.7 million PLHIV, 73% had access to ART and 66% had achieved viral suppression[4]. Uganda in particular, by 2020, out of the 1.4 million PLHIV, 91% knew their HIV status, 90% were on ART and 82% had viral suppression[5]. In order to achieve benefits of early ART initiation, PLHIV on ART must be virologically suppressed[6, 7], which hinges on effective behavior change interventions by HIV care providers, health sector leadership and PLHIV themselves to facilitate good adherence to ART[8]. Good ART adherence can be defined as properly following treatment provider recommendations regarding ART dosage, frequency and timing of swallowing medication[9]. Poor ART adherence is a major cause of treatment failure in PLHIV[10] and ensuring sustained adherence to ART can achieve viral suppression except for presence of HIV drug resistance[10]. If a person living with HIV is virally unsuppressed, he or she will have slow immune system recovery, HIV disease advancement, increased morbidity and an enhanced HIV infection transmission risk[11]. ART-associated side effects, younger age, substance use, depression and forgetting dosing time are linked to sub-optimal ART adherence [12]. Additionally, individual ART initiation incentive, education level, duration on ART, stigmatization and HIV status disclosure affect ART adherence [13]. HIV virological failure is a common challenging problem, even after Intensive Adherence Counseling of adult PLHIV. According to the recent Uganda Population-Based HIV Impact Assessment [14] 2020-2021, the prevalence of Viral Load Suppression (VLS) among adults (ages 15 years and older) living with HIV in Uganda stands at 75.4% [14]. TASO Mbale treatment centre is located in Mid-Eastern of Uganda, which has registered a lowest VLS (60.3%) as compared to Southwestern region (82.8%). A study conducted in central Uganda showed that the proportion of children living with HIV receiving ART who had a VL non-suppression after six months of ART at the pediatric HIV/AIDS clinic at Joint Clinic Research Centre (JCRC) was 23% (Nabukeera S, Kagaayi J, Makumbi FE, Mugerwa H, Matovu JKB, 2021). Whereas this study enrolled caregivers of children living with HIV, it did not look at the adult PLHIV. The proportion of adult PLHIV with non-suppressed VL after IAC is not known and the factors for Non-suppression are equally not known, for which this study was conducted. No such a study has been conducted in eastern Uganda specifically Mbale. In addition to that, there have been few studies on the factors associated with of virological non-suppression after IAC among adult patients on antiretroviral therapy in Uganda in general, and there is variation across clients and settings for unknown reasons. Some identified predictors of non-suppression such as; poor drug adherence, use of sub-optimal drug combinations, previous ARV exposure alcohol or drug abuse, stage in which the patient is based on WHO, low CD4 +count, high viral load, TB co-infection, time on ART, Time from HIV diagnosis to ART start (weeks), non-Adherence to ARVs, duration on treatment and Treatment line[1]. The aim of this study was to determine the factors associated with virological non-suppression among adult PLHIV after intensive adherence counseling at TASO Mbale treatment centre, Eastern Uganda. 2. Methods Study design and setting: This was a Cross-sectional study design. The study used TASO Mbale program data for the period between Jan 2018 and August 2021. The study was conducted in TASO Mbale center of Excellence, located in Mbale Hospital, Mbale Town/Municipality in Mbale District in Eastern Uganda. TASO Mbale is one of the 11 centers of TASO Organizations that provide prevention, care and treatment for people living with HIV/AIDS/TB. It has a population of over 7,285 active clients on ART. VL- testing as a model of monitoring treatment adherence was rolled out by MOH and adapted in 2015/2016 at TASO Mbale. Mbale city is approximately 210km from the Kampala city. It has two HCIVs and one regional referral hospital. TASO Mbale, which is within Mbale city provides comprehensive HIV/AIDS prevention, care, and support to the population of Mbale, Sironko, Budaka, Kibuku, Kumi, Butaleja, Bulambuli, Manafwa, Butebu, Palisa, Bukedea, Kacumbala, Budadiri, Bududa, Tororo, Jinja among other places around Mbale. Study population and sample selection : Figure 2 below shows a schematic flow chart showing how participants were enrolled for analysis. A total of 607 clients with VL >1000 copies/ml who were receiving treatment at TASO Mbale were retrieved for the period Jan 2018 to August 2021. Of which 450 clients were active and 157 were inactive (died or lost to follow-up). Four hundred forty two (442) of the active clients had undergone IAC whereas 8 clients did not undergo IAC at the time of follow-up visit. The 442 clients were considered for analysis. Study Variables and measurement Dependent variable ; The study looked at the viral load outcomes of patients with suppressed and /or non-suppressed viral load among clients in TASO Mbale Centre. The independent variables; are age -we considered adults 18years and above, sex-male and female, the WHO staging (stage 1, 2, 3 & 4). The intensive adherence counseling (IAC), the regimen-baseline and current regimen, nutritional status-green-well nourished, Red-severe malnutrition and yellow-moderate malnutrition, treatment supporter-present or absent and residence-Urban within Mbale city and Rural-outside Mbale municipality. Inclusion and Exclusion Inclusion criteria All clients who had been on ART for at least 6 months, have had a viral load measure done with results in the system and VL ≥ 1000C/ml are active Exclusion criteria Those not completing 3 sessions of EAC after first high viral load results Participants below the age of 18 years old Those living with HIV, not on Antiretroviral therapy The study also excluded all clients who are inactive (lost to follow up, dead, and transferred out) Data source : Secondary data were retrieved from TASO Mbale treatment centre database. Data were retrieved from PLHIV on ART who had their viral load measured between Jan 2018 and August 2021. The retrieval was conducted in December 2022. 3.7 Data abstraction The data were abstracted from the TASO Mbale program database regarding the PLHIV socio demographic and clinical, ART drug regimen, and virological characteristics. The abstraction was done December 2022 for the period; January 2018 through August 2021. Data management and quality control : The data retrieved from TASO Mbale program database for the period Jan 2018 to August 2021 were extracted in spreadsheet format. Data cleaned, and sorted, then exported to STATA for analysis.The validity of the data was enhanced by a standardized record-keeping system of the TASO Mbale treatment centre database. These records are normally readily available and regularly updated by the Monitoring and Evaluation officers and data clerks during each Patient visit. Data recorded from the register at the treatment centre were found to be similar to the data in the database. The reliability of this study was ensured by consistently using the same data entered on the treatment centre database from the registers. Data processing and analysis . The data were declared as survival time-data using stset command in STATA version 14.0 package (Stata-Corp. 2014. Stata Statistical Software: Release 14. College Station, TX: Stata-Corp LLC). The follow-up time in months was set as the failure time. Whereas the failure variable was referred to as VL non-suppression. The follow-up time in months was computed as the difference in dates of VL tests after IAC during the follow-up period. This was done to obtain the total time at risk and overall contribution of a patient time during the follow-up period. Descriptive statistics were summarized using frequency and proportions for categorical variables, whereas continuous variables were summarized with a measure of central tendency with corresponding measures of dispersion. Incident rates were estimated for the events of viral load suppression and viral load non-suppression. Bivariate analysis was done for all covariates. Hazard ratios (CHRs) were estimated as a degree of association between viral non-suppression and client features, via a Cox proportional hazards regression. Variables with p -values less than 0.10 in the bivariate analysis were included in the multivariable analysis reporting adjusted hazard ratios (AHRs), whereas variables with a p -value ≤ 0.05 were measured as statistically significant determinants of viral non-suppression, with a 95% CI. Ethical consideration . Ethical approval was sought from the Research Ethics Committee, REC Mbale Hospital. The study administrative clearances from both department of public health of Busitema University and TASO Mbale treatment centre. A wavier of consent was obtained from the IRB since the study was retrospective and will use the identified data for analysis. The Uganda National council for science and technology also provided approval. The data retrieved from TASO Mbale treatment centre was kept confidential and patients’ identity was not retrieved. 3. Results 3.1 Socio-demographic characteristics Table 1 below shows the socio-demographic characteristics of PLHIV. Four hundred forty two (442) PLHIV underwent through Intensive Adherence Counseling at TASO Mbale for the period Jan 2018 to August 2021. Of these, 361(81.67) aged more than 35 years. The mean age was 45.46 years with standard deviation 13.05 years Table 1: Socio-demographic characteristics of PLHIV receiving treatment at TASO Mbale from Jan 2018 – August 2021 Characteristic Sub-category Frequency Percentage (%) Age(years) 18-35 81 18.33 >35 361 81.67 Mean ± Stdev 45.46±13.05 Sex Female 289 65.38 Male 153 34.62 Place of residence Rural 336 76.02 Urban 106 23.98 Treatment supporter No 166 37.56 Yes 276 62.44 Stay together with treatment supporter No 413 93.44 Yes 29 06.56 3.2 The clinical and behavioral characteristics The clinical characteristics in this study were the timing of ART initiation, WHO clinical stages of HIV, baseline ART drug regimens, co-infections such as TB and ART regimen after IAC. Meanwhile, the behavioral characteristics were the adherence levels and nutritional status. At the time of ART initiation, 292 (66.06%) of the PLHIV were initiated late on ART, 337(76.24) were at the WHO clinical stage 2 of HIV. On the baseline ART regimen, 140 (31.67%) were on AZT-3TC-NVP and 174(39.37%) were on other 1 st line ART drug regimen not specified in the data. After IAC, 367(83.03%) PLHIV had been switched to TDF/3TC/DTG regimen. Table 2: Clinical and behavioral characteristics of PLHIV receiving treatment at TASO Mbale from Jan 2018 – August 2021 Characteristic Sub-category Frequency Percentage Timing of ART initiation Early initiation 150 33.94 Late initiation 292 66.06 WHO Clinical stage WHO clinical stage 1 99 22.40 WHO clinical stage 2 337 76.24 WHO clinical stage 3 05 01.13 WHO clinical stage 4 01 00.23 Baseline ART Drug Regimen ABC-3TC-EFV 01 00.23 AZT-3TC-EFV 52 11.76 AZT-3TC-NVP 140 31.67 D4T-3TC-EFV 05 01.13 D4T-3TC-NVP 17 03.85 TDF-3TC-EFV 10 02.26 TDF-3TC-NVP 36 08.14 TDF-FTC-NVP 01 00.23 Other 1 st line Regimen 174 39.37 Missing baseline Regimen 06 01.36 Adherence level Poor Adherence 08 01.81 Good Adherence 434 98.19 TB status No 431 97.51 Yes 11 02.49 Nutritional status/MUAC Green 422 95.48 Red 03 00.68 Yellow 17 03.85 ART Regimen after IAC ABC-3TC-ATV/r 21 04.75 ABC-3TC-LPV/r 02 00.45 ABC/3TC/DTG 14 03.17 AZT-3TC-ATV/r 06 01.36 AZT-3TC-LPV/r 01 00.23 AZT/3TC/DTG 08 01.81 TDF-3TC-ATV/r 12 02.71 TDF-3TC-EFV 03 00.68 TDF-3TC-LPV/r 06 01.36 TDF/3TC/DTG 367 83.03 OTHER 02 00.45 3.3 The proportion of virological suppression and non-suppression of PLHIV after IAC receiving treatment at TASO Mbale Centre between Jan 2018 and August 2021 The PLHIV who received IAC were followed for different periods with a total of 13, 428 person-months (PM) of observations. In this follow-up period, a total of 382 (86.4%) were virologically suppressed and their counterparts developed viral load non-suppression 60(13.6%) (Figure 3). Hence, the overall rates of VL suppression was 28.45 (25.70-31.40) and that of VL non-suppression was 4.47 (3.41-5.75) per 1000 person-months (PM) of observation after IAC. 3.4 Factors associated with non-virological suppression after IAC 3.4.1 Bivariate analysis In the bivariate analysis, Cox proportional hazard regression analysis reporting crude Hazard ratio (CHR) for socio-demographics and clinical characteristics of PLHIV; sex, age, residence, treatment supporter availability, staying with treatment supporter, ART regimen, ART adherence level, nutritional status, and clinical stage were all ran independently with VL non-suppression. Five variables emerged to be significantly associated with VL non-suppression that is ART regimen, nutritional status, clinical stage, ART adherence level and client staying with a treatment supporter. Table 3 : Bivariate analysis for factors associated with viral load non-suppression among adult PLHIV after IAC in eastern region-Uganda from January 2018 to August 2021 (N=442) Variable & category Total (N=442) Non-suppression, n(%) CHR (95% CI) p-value Age 18-35 81(100.00) 15(18.52) Ref. ≥35 361(100.00) 45(12.47) 0.64(0.354-1.147) 0.113 Sex Female 289(100.00) 37(12.80) Ref. Male 153(100.00) 23(15.03) 1.33(0.795-2.255) 0.272 Place of residence Rural 336(100.00) 49(14.58) Ref. Urban 106(100.00) 11(10.38) 0.77(0.397-1.475) 0.424 Treatment supporter No 166(100.00) 21(12.65) Ref. Yes 276(100.00) 39(14.13) 1.27(0.748-2.169) 0.374 Stay together with treatment supporter No 413(100.00) 51(12.35) Ref. Yes 29(100.00) 09(31.03) 2.84(1.395-5.794) 0.004* Timing of ART initiation Early initiation 150(100.00) 21(14.00) Ref. Late initiation 292(100.00) 39(13.36) 0.74(0.435-1.260) 0.268 WHO Clinical stage WHO clinical stage 1 99(100.00) 13(13.13) Ref. WHO clinical stage 2 337(100.00) 44(13.06) 1.22(0.656-2.269) 0.530 WHO clinical stage 3 05(100.00) 03(60.00) 3.43(0.948-12.378) 0.060* WHO clinical stage 4 01(100.00) 00(00.00) 5.22e-15 1.000 Adherence level Good Adherence 434(100.00) 55(12.67) Ref. Poor Adherence 08(100.00) 05(62.50) 4.02(1.568-10.304) 0.004* TB status No 431(100.00) 57(13.23) Ref. Yes 11(100.00) 03(27.27) 2.01(0.627-6.433) 0.240 Nutritional status/MUAC Green 422(100.00) 56(13.27) Ref. Red 03(100.00) 01(33.33) 8.59(1.152-63.962) 0.036* Yellow 17(100.00) 03(17.65) 1.15(0.358-3.706) 0.813 ART Regimen after IAC ABC-3TC-ATV/r 21(100.00) 06(28.57) Ref. ABC-3TC-LPV/r 02(100.00) 00(00.00) 6.85e‑19 - ABC/3TC/DTG 14(100.00) 03(21.43) 1.25(0.306-5.071) 0.759 AZT-3TC-ATV/r 06(100.00) 03(50.00) 1.94(0.479-7.826) 0.354 AZT-3TC-LPV/r 01(100.00) 01(100.00) 8.62(1.006-73.791) 0.049* AZT/3TC/DTG 08(100.00) 02(25.00) 2.90(0.565-14.839) 0.202 TDF-3TC-ATV/r 12(100.00) 02(16.67) 1.00(0.195-4.883) 0.976 TDF-3TC-EFV 03(100.00) 01(33.33) 2.75(0.327-23.200) 0.351 TDF-3TC-LPV/r 06(100.00) 03(50.00) 3.94(0.963-16.113) 0.056* TDF/3TC/DTG 367(100.00) 39(10.63) 0.47(0.198-1.113) 0.086* OTHER 02(100.00) 00(00.00) 6.52e‑19(0 - ) 1.000 Statistical Note: Asterisk (*) p<0.1 3.4.2 Multivariable analysis In multivariable analysis after adjusting for sex, age, residence, treatment supporter availability, staying with treatment supporter, ART regimen, ART adherence level, nutritional status, and clinical stage, two factor variables emerged to be significantly associated with VL non-suppression including ART regimen and ART adherence level. Table 4: Multivariable analysis for factors associated with viral load non-suppression among adult PLHIV after IAC in eastern region-Uganda from January 2018 to August 2021 (N=442) Variable & category Total(N=442) Non-suppression, n(%) AHR(95% CI) p-value Stay together with treatment supporter No 413(100.00) 51(12.35) Ref. Yes 29(100.00) 09(31.03) 2.02(0.893-4.548) 0.091 WHO Clinical stage WHO clinical stage 1 99(100.00) 13(13.13) Ref. WHO clinical stage 2 337(100.00) 44(13.06) 1.13(0.570-2.220) 0.570 WHO clinical stage 3 05(100.00) 03(60.00) 0.63(0.112-3.563) 0.604 WHO clinical stage 4 01(100.00) 00(00.00) 8.68e-19(-) - Adherence level Good Adherence 434(100.00) 55(12.67) Ref. Poor Adherence 08(100.00) 05(62.50) 4.88(1.607-14.836) 0.005*** Nutritional status/MUAC Green 422(100.00) 56(13.27) Ref. Red 03(100.00) 01(33.33) 3.12(0.336-29.042) 0.317 Yellow 17(100.00) 03(17.65) 0.35(0.065-1.822) 0.210 ART Regimen after IAC ABC-3TC-ATV/r 21(100.00) 06(28.57) Ref. ABC-3TC-LPV/r 02(100.00) 00(00.00) 4.48e-19(-) - ABC/3TC/DTG 14(100.00) 03(21.43) 0.97(0.232-4.027) 0.963 AZT-3TC-ATV/r 06(100.00) 03(50.00) 1.22(0.271-5.496) 0.795 AZT-3TC-LPV/r 01(100.00) 01(100.00) 44.70(1.579-1265.056) 0.026** AZT/3TC/DTG 08(100.00) 02(25.00) 1.96(0.338-11.396) 0.452 TDF-3TC-ATV/r 12(100.00) 02(16.67) 0.86(0.170-4.323) 0.852 TDF-3TC-EFV 03(100.00) 01(33.33) 2.71(0.323-22.840) 0.358 TDF-3TC-LPV/r 06(100.00) 03(50.00) 5.78(1.137-29.384) 0.034** TDF/3TC/DTG 367(100.00) 39(10.63) 0.43(0.178-1.048) 0.063 OTHER 02(100.00) 00(00.00) 1.55e-19(-) - Statistical Note: Asterisk (**) p<0.05, ***p<0.01 4. Discussion The proportion virological non-suppression among adult PLHIV after IAC The virological non-suppression (13.6%) found in the current study is significantly lower than the third UNAIDS set goal of having a viral suppression of 95% on ART[15]. The result from this study is similar with that from Cameroon, where the virological non-suppression was reported at 11.8%[16]. These results are attributed to enhanced education of patient during their treatment visits and IAC. The finding in this study is inconsistent with results from similar studies conducted in Uganda, Kenya, South Africa and Tanzania (20-32.8%)[10]. This variation may be attributed to the differences in the quality of care in service delivery more so IAC and other adherence support activities[17]. Factors associated with virological non-suppression among PLHIV after IAC at TASO Mbale Our study found a significant association between adherence level and HIV virological non-suppression, (AHR=4.88, 95% CI: 1.607-14.836 p=0.005). For example, patients who had Poor adherence level had a five-fold risk of being VL non-suppressed as compared to patients with good adherence levels. This is in agreement of findings of other [10]. Good adherence level has been associated with better virological suppression as well as improved immunological and clinical outcomes[18]. The study further reports a significant association between virological suppression and ART drug regimen after IAC. Whereas there is a variation in drug regimens the NVP-based and the DTG-based regimens. The TDF/3TC/DTG regimen was significantly associated with viral load suppression, AHR=5.78, 95% CI: 1.137-29.384, p=0.034. Patients who were switched to TDF/3TC/DTG ARV regimen were 5.0 times likely to virological loads unsuppressed as compared to those on other ARV regimens. This finding is comparable to another study conducted in Uganda[19]. In general, these finding seem to lend support to the WHO current guidelines as the first ART regimen. The regimen has a higher barrier to resistance compared with NRTIs and NNRTIs-based regimens [10]. This study also indicated that the place of residence of the patients and viral load suppression had no association, meaning that the place of residence whether rural or urban does not in any way significantly affect the viral load suppression. This finding is in agreement with the growing body of literature that provides evidence that location where the patient resides in terms of distance from the treatment centre is not necessarily a barrier that can affect viral load suppression[20]. About age and virological non-suppression, since the current study was conducted among adults, it is conceivable that adults usually have been on ART for long periods, therefore they suffer medication fatigue and miss appointments leading to poor adherence[21]. Surprisingly, the findings from this study did not show any significant association between age and virological non-suppression. This finding is consistent with those in Kenya[22] and Tanzania[23] who also found no significant association between age and virological non-suppression. The study found no association between TB co-infection with virological non-suppression, which was also reported in previous studies[19, 24]. The possible explanation to this lack of association could be attributed to the small number of participants diagnosed with TB. The current study did not show a significant association between WHO clinical stages. This is in agreement with another study conducted in Uganda[25]. However, this is inconsistent with a study in Ethiopia[26] that showed increased likelihood of virological non-suppression in WHO clinical stage 2 compared to stage 1. Furthermore, studies in Swaziland[27] and Nigeria[28] found that WHO clinical stages 3 or 4 were significantly associated with virological non-suppression. To explain this variation, in the current study there were very few patients in WHO clinical stages 3 and 4. This might have contributed to no significant association during the analysis in this study. 5.3 Strengths and limitations of the study To the best of the researcher’s knowledge, this is the first study to provide up-to-date findings on proportion of virologically non-suppressed PLHIV after IAC and the determinants using TASO Mbale centre program data. Nonetheless, this study has some limitations that must be acknowledged. The major limitation was the usage of program data that was not collected for research purposes, which handicapped the researcher as regards the exposure variables that could be studied. The limitation was that the researcher did not analyze variables such marital status, distance from the treatment centre, income levels, education status, occupation, culture and religion. These variables could have concealed socio-demographic confounders because they not routinely collected at the TASO treatment centre. The study is also limited by the fact that it is based on retrospective information provided by the respondents at the time of each visit at the treatment centre which may subject to recall bias. Furthermore, some participants were either lost to follow up, dead or transferred out patients, which might have caused an under or over estimation virological non-suppression. 5. Conclusion In conclusion, Out of 442 clients with non-suppressed viral load retrieved after IAC, 13.6% did not achieve viral load suppression after IAC. This could be as a result of poor adherence levels to ART. The study revealed that poor adherence to ART was significantly associated with VL non-suppression following IAC. The ART regimen of the patient, especially DTG and AZT based regimen contributed to many clients being able to achieve viral load suppression. Viral load non-suppression was statistically significant to the TDF-3TC-LPV/r ART regimen of the clients. The Socio-demographic and clinical characteristics including; age, sex, treatment supporter, TB status, and nutritional status did not have any significant statistical relationship in VL non-suppression. The virological suppression of PLHIV after IAC is very vital towards the achievement of MoH adopted 95-95-95 targets. To avert the gaps in HIV treatment at regional, national and international levels. We recommend that, there is need to do more drug resistance testing for clients who do not achieve viral load suppression after IAC, all clients who are switched to DTG based regimen and do not achieve viral load suppression will benefit from drug resistance testing and clients with persistent viral load non-suppression should be switched to another regimen after IAC as per the Uganda Ministry of Health guidelines. Declarations Author Contributions: [a short paragraph specifying their individual contributions must be provided]. The following statements should be used “Conceptualization, X.X. and Y.Y.; methodology, X.X.; software, X.X.; validation, X.X., Y.Y. and Z.Z.; formal analysis, X.X.; investigation, X.X.; resources, X.X.; data curation, X.X.; writing—original draft preparation, X.X.; writing—review and editing, X.X.; visualization, X.X.; supervision, X.X.; funding acquisition, Y.Y. All authors have read and agreed to the published version of the manuscript.” Funding: This research received no external funding Institutional Review Board Statement: In this section, you should add the Institutional Review Board Statement and approval number, if relevant to your study. Informed Consent Statement: Not applicable for this study. Data Availability Statement: Acknowledgments: I appreciate the support of the statistician and the guidance of my supervisors. Conflicts of Interest: The authors declare no conflict of interest. References UNAIDS, UNAIDS. Ending the AIDS epidemic by 2030. Available from: https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf . 2020. UNAIDS, UNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. 2014 [cited 12 April 2023]. Available from: https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf . 2014. WHO, World Health Organization. Antiretroviral therapy and on Pre-Exposure Prophylaxis for HIV. 2015 [cited 12 April 2023]. Available from: https://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf?sequence=1 . 2015. UNAIDS, UNAIDS, Global HIV, AIDS statistics - fact sheet. &. 2022 [cited 12 April 2023]. Available from: https://www.unaids.org/en/resources/fact-sheet . 2022. UNAIDS, UNAIDS, Uganda HIV. & AIDS estimates. Country factsheets. 2022 [cited 12 April 2023]. Available from: https://www.unaids.org/en/regionscountries/countries/uganda . 2022. Renju, J., et al., ‘Side effects’ are ‘central effects’ that challenge retention in HIV treatment programmes in six sub-Saharan African countries: a multicountry qualitative study. Sexually transmitted infections, 2017. 93 (Suppl 3). Wringe, A., et al., Bottlenecks to HIV care and treatment in sub-Saharan Africa: a multi-country qualitative study . 2017, BMJ Publishing Group Ltd. Michie, S., M.M. Van Stralen, and R. West, The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 2011. 6 (1): p. 1-12. Cramer, J.A., et al., Medication compliance and persistence: terminology and definitions. Value in health, 2008. 11 (1): p. 44-47. !!! INVALID CITATION !!! . !!! INVALID CITATION !!! (Cohen et al., 2016; Group, 2015; Okulicz et al., 2015; Rodger et al., 2019; WHO, 2015). !!! INVALID CITATION !!! (Bulage et al., 2017; Bvochora et al., 2019). !!! INVALID CITATION !!! (Bulage et al., 2017; Haberer et al., 2017; Thompson et al., 2012). UPHIA, Uganda Population-Based HIV Impact Assessment (UPHIA) 2020-2021. 2022. UNAIDS., UNAIDS (2021) 2025 aids targets. Ending AIDS epidemic by 2030. Geneva; Joint United Nations Programme on HIV/AIDS. World AIDS Day Report 2020, pp 42–68, https://doi.org/10.18356/9789210055475c005 . 2021. Djiyou, A.B., et al., Viral load suppression in HIV-infected adolescents in cameroon: towards achieving the UNAIDS 95% viral suppression target. BMC pediatrics, 2023. 23 (1): p. 119. Nabukeera, S., et al., Factors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda. PLoS One, 2021. 16 (1): p. e0246140. Martelli, G., et al., Adherence to antiretroviral treatment among children and adolescents in Tanzania: comparison between pill count and viral load outcomes in a rural context of Mwanza region. PloS one, 2019. 14 (3): p. e0214014. Agegnehu, C.D., M.W. Merid, and M.K. Yenit, Incidence and predictors of virological failure among adult HIV patients on first-line antiretroviral therapy in Amhara regional referral hospitals; Ethiopia: a retrospective follow-up study. BMC Infectious Diseases, 2020. 20 (1): p. 1-14. Sahay, S., K.S. Reddy, and S. Dhayarkar, Optimizing adherence to antiretroviral therapy. The Indian journal of medical research, 2011. 134 (6): p. 835. !!! INVALID CITATION !!! (Desta et al., 2020; Jobanputra et al., 2015). Mwangi, A. and B. van Wyk, Factors associated with viral suppression among adolescents on antiretroviral therapy in Homa Bay County, Kenya: a retrospective cross-sectional study. HIV/AIDS-Research and Palliative Care, 2021: p. 1111-1118. Muri, L., et al., Development of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern. AIDS (London, England), 2017. 31 (1): p. 61. Negash, H., et al., Increased virological failure and determinants among HIV patients on highly active retroviral therapy in Adigrat General Hospital, Northern Ethiopia, 2019: hospital-based cross-sectional study. Infection and Drug Resistance, 2020: p. 1863-1872. Natukunda, J., et al., Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study. Tropical medicine and health, 2019. 47 (1): p. 1-10. Desta, A.A., et al., HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study. BMC infectious diseases, 2020. 20 : p. 1-10. Jobanputra, K., et al., Factors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland. PloS one, 2015. 10 (2): p. e0116144. Greig, J.E., et al., Predictors of raised viral load during antiretroviral therapy in patients with and without prior antiretroviral use: a cross-sectional study. PLoS One, 2013. 8 (8): p. e71407. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-3975082","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":274233692,"identity":"c9cd86ad-f66c-45a1-86d4-9004df20d51d","order_by":0,"name":"Alice Apio","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYFACxgYGhgIJIIP5AJCQkCFSiwFIC1sCSAsPkTYZgAgeCElQMf/s5sYHPwws7Pmlez6/ulFjwcPAfvjoBnxaJO4cbDbsMZBInDnn7DbrnGNAh/Gkpd3Aa82NxDYJHgOJBIMbuduMc9iAWiR4zPBqkQdqkfxjIGFvcCPnmXHOPyK0GAC1SANtYdxwI4f5cW4bEVoMgX4xlgH5ZUaaGXNunwQPGyG/yN1uf/jwTUWdPb9E8uPPOd/q5PjZDx/D730JBJMNzGbDqxxNC/MHgqpHwSgYBaNgRAIAeA5EYdToZQsAAAAASUVORK5CYII=","orcid":"","institution":"Busitema University","correspondingAuthor":true,"prefix":"","firstName":"Alice","middleName":"","lastName":"Apio","suffix":""},{"id":274233693,"identity":"95d19623-50b8-4af9-9bb8-10eaf7fe8d0a","order_by":1,"name":"David Jonah Soita","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Jonah","lastName":"Soita","suffix":""},{"id":274233694,"identity":"e1392326-5d3f-47d6-a2d1-f006eedf7792","order_by":2,"name":"JP Masaba","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"JP","middleName":"","lastName":"Masaba","suffix":""},{"id":274233695,"identity":"4a6e1d80-d044-4838-8c8a-01607ef992f3","order_by":3,"name":"JKB Matovu","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"JKB","middleName":"","lastName":"Matovu","suffix":""},{"id":274233696,"identity":"f400a1a0-35cd-4fb5-b7b2-408cfa556e6c","order_by":4,"name":"David Mukunya","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Mukunya","suffix":""},{"id":274233697,"identity":"2faebfaa-1fb9-4b2c-81d0-708309429331","order_by":5,"name":"Samuel Ojera","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Ojera","suffix":""}],"badges":[],"createdAt":"2024-02-21 09:32:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3975082/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3975082/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51564009,"identity":"a86a64ad-b1a1-4a8d-8f03-5e489baa9575","added_by":"auto","created_at":"2024-02-23 18:53:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":292773,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 2: Schematic presentation of participants’ selection at TASO Mbale centre between Jan 2018 and August 2021\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3975082/v1/44a212bfd5a7f684bb0c74e4.jpg"},{"id":51563242,"identity":"813d95f3-788e-47df-bfda-8d8c1fc57fbc","added_by":"auto","created_at":"2024-02-23 18:45:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":129472,"visible":true,"origin":"","legend":"\u003cp\u003eFigure 3: The proportion of virological suppression status of PLHIV after IAC at TASO Mbale between Jan 2018 and August 2021\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3975082/v1/911cd4ad4a40e2017dd6f562.jpg"},{"id":63734403,"identity":"cb917fb5-8376-405f-822b-865b8ae27aae","added_by":"auto","created_at":"2024-09-01 15:54:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1446481,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3975082/v1/bc5a0fae-2f81-4b52-b3ee-7e497ecf43be.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with Virological non-suppression among adult PLHIV after receiving Intensive Adherence Counseling at Taso Mbale, Eastern Uganda: A Cross-sectional Study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eAccording to UNAIDS, 95% of PLHIV on ART should be virally suppressed as was ambitiously set through United Nations\u0026rsquo; 95-95-95 target[1] fast tracking the sustainable development goal to end the HIV epidemic by 2030[2, 3]. Globally, in 2020, out of 37.7 million PLHIV, 73% had access to ART and 66% had achieved viral suppression[4]. Uganda in particular, by 2020, out of the 1.4 million PLHIV, 91% knew their HIV status, 90% were on ART and 82% had viral suppression[5]. In order to achieve benefits of early ART initiation, PLHIV on ART must be virologically suppressed[6, 7], which hinges on effective behavior change interventions by HIV care providers, health sector leadership and PLHIV themselves to facilitate good adherence to ART[8].\u003c/p\u003e\n\u003cp\u003eGood ART adherence can be defined as properly following treatment provider recommendations regarding ART dosage, frequency and timing of swallowing medication[9]. Poor ART adherence is a major cause of treatment failure in PLHIV[10] and ensuring sustained adherence to ART can achieve viral suppression except for presence of HIV drug resistance[10]. If a person living with HIV is virally unsuppressed, he or she will have slow immune system recovery, HIV disease advancement, increased morbidity and an enhanced HIV infection transmission risk[11]. ART-associated side effects, younger age, substance use, depression and forgetting dosing time are linked to sub-optimal ART adherence [12]. Additionally, individual ART initiation incentive, education level, duration on ART, stigmatization and HIV status disclosure affect ART adherence [13].\u003c/p\u003e\n\u003cp\u003eHIV virological failure is a common challenging problem, even after Intensive Adherence Counseling of adult PLHIV. According to the recent Uganda Population-Based HIV Impact Assessment [14] 2020-2021, the prevalence of Viral Load Suppression (VLS) among adults (ages 15 years and older) living with HIV in Uganda stands at 75.4% [14]. TASO Mbale treatment centre is located in Mid-Eastern of Uganda, which has registered a lowest VLS (60.3%) as compared to Southwestern region (82.8%). A study conducted in central Uganda showed that the proportion of children living with HIV receiving ART who had a VL non-suppression after six months of ART at the pediatric HIV/AIDS clinic at Joint Clinic Research Centre (JCRC) was 23% (Nabukeera S, Kagaayi J, Makumbi FE, Mugerwa H, Matovu JKB, 2021). Whereas this study enrolled caregivers of children living with HIV, it did not look at the adult PLHIV. The proportion of adult PLHIV with non-suppressed VL after IAC is not known and the factors for Non-suppression are equally not known, for which this study was conducted. No such a study has been conducted in eastern Uganda specifically Mbale.\u003c/p\u003e\n\u003cp\u003eIn addition to that, there have been few studies on the factors associated with of virological non-suppression after IAC among adult patients on antiretroviral therapy in Uganda in general, and there is variation across clients and settings for unknown reasons. Some identified predictors of non-suppression such as; poor drug adherence, use of sub-optimal drug combinations, previous ARV exposure alcohol or drug abuse, stage in which the patient is based on WHO, low CD4 +count, high viral load, TB co-infection, time on ART, Time from HIV diagnosis to ART start (weeks), non-Adherence to ARVs, duration on treatment and Treatment line[1]. The aim of this study was to determine the factors associated with virological non-suppression among adult PLHIV after intensive adherence counseling at TASO Mbale treatment centre, Eastern Uganda.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting:\u003c/strong\u003e This was a Cross-sectional study design. The study used TASO Mbale program data for the period between Jan 2018 and August 2021. The study was conducted in TASO Mbale center of Excellence, located in Mbale Hospital, Mbale Town/Municipality in Mbale District in Eastern Uganda. TASO Mbale is one of the 11 centers of TASO Organizations that provide prevention, care and treatment for people living with HIV/AIDS/TB. It has a population of over 7,285 active clients on ART. VL- testing as a model of monitoring treatment adherence was rolled out by MOH and adapted in 2015/2016 at TASO Mbale. Mbale city is approximately 210km from the Kampala city. It has two HCIVs and one regional referral hospital.\u003c/p\u003e\n\u003cp\u003eTASO Mbale, which is within Mbale city provides comprehensive HIV/AIDS prevention, care, and support to the population of Mbale, Sironko, Budaka, Kibuku, Kumi, Butaleja, Bulambuli, Manafwa, Butebu, Palisa, Bukedea, Kacumbala, Budadiri, Bududa, Tororo, Jinja among other places around Mbale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population and sample selection\u003c/strong\u003e\u003cstrong\u003e: \u003c/strong\u003eFigure 2 below shows a schematic flow chart showing how participants were enrolled for analysis. A total of 607 clients with VL \u0026gt;1000 copies/ml who were receiving treatment at TASO Mbale were retrieved for the period Jan 2018 to August 2021. Of which 450 clients were active and 157 were inactive (died or lost to follow-up). Four hundred forty two (442) of the active clients had undergone IAC whereas 8 clients did not undergo IAC at the time of follow-up visit. The 442 clients were considered for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Variables and measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e; The study looked at the viral load outcomes of patients with suppressed and /or non-suppressed viral load among clients in TASO Mbale Centre.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe independent variables;\u003c/strong\u003e are age -we considered adults 18years and above, sex-male and female, the WHO staging (stage 1, 2, 3 \u0026amp; 4). The intensive adherence counseling (IAC), the regimen-baseline and current regimen, nutritional status-green-well nourished, Red-severe malnutrition and yellow-moderate malnutrition, treatment supporter-present or absent and residence-Urban within Mbale city and Rural-outside Mbale municipality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and Exclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll clients who had been on ART for at least 6 months, have had a viral load measure done with results in the system and VL \u0026ge; 1000C/ml are active\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eThose not completing 3 sessions of EAC after first high viral load results\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eParticipants below the age of 18 years old\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThose living with HIV, not on Antiretroviral therapy\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe study also excluded all clients who are inactive (lost to follow up, dead, and transferred out)\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData source\u003c/strong\u003e\u003cstrong\u003e: \u003c/strong\u003eSecondary data were retrieved from TASO Mbale treatment centre database. Data were retrieved from PLHIV on ART who had their viral load measured between Jan 2018 and August 2021. The retrieval was conducted in December 2022.\u003c/p\u003e\n\u003cp\u003e3.7 Data abstraction\u003c/p\u003e\n\u003cp\u003eThe data were abstracted from the TASO Mbale program database regarding the PLHIV socio demographic and clinical, ART drug regimen, and virological characteristics. The abstraction was done December 2022 for the period; January 2018 through August 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and quality control\u003c/strong\u003e\u003cstrong\u003e: \u003c/strong\u003eThe data retrieved from TASO Mbale program database for the period Jan 2018 to August 2021 were extracted in spreadsheet format. Data cleaned, and sorted, then exported to STATA for analysis.The validity of the data was enhanced by a standardized record-keeping system of the TASO Mbale treatment centre database. These records are normally readily available and regularly updated by the Monitoring and Evaluation officers and data clerks during each Patient visit. Data recorded from the register at the treatment centre were found to be similar to the data in the database. The reliability of this study was ensured by consistently using the same data entered on the treatment centre database from the registers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eThe data were declared as survival time-data using \u003cem\u003estset\u003c/em\u003e command in STATA version 14.0 package (Stata-Corp. 2014. Stata Statistical Software: Release 14. College Station, TX: Stata-Corp LLC). The follow-up time in months was set as the failure time. Whereas the failure variable was referred to as VL non-suppression. The follow-up time in months was computed as the difference in dates of VL tests after IAC during the follow-up period. This was done to obtain the total time at risk and overall contribution of a patient time during the follow-up period.\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were summarized using frequency and proportions for categorical variables, whereas continuous variables were summarized with a measure of central tendency with corresponding measures of dispersion. Incident rates were estimated for the events of viral load suppression and viral load non-suppression. Bivariate analysis was done for all covariates. Hazard ratios (CHRs) were estimated as a degree of association between viral non-suppression and client features, via a Cox proportional hazards regression. Variables with \u003cem\u003ep\u003c/em\u003e-values less than 0.10 in the bivariate analysis were included in the multivariable analysis reporting adjusted hazard ratios (AHRs), whereas variables with a \u003cem\u003ep\u003c/em\u003e-value \u0026le; 0.05 were measured as statistically significant determinants of viral non-suppression, with a 95% CI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003cstrong\u003e. \u003c/strong\u003eEthical approval was sought from the Research Ethics Committee, REC Mbale Hospital. The study administrative clearances from both department of public health of Busitema University and TASO Mbale treatment centre. A wavier of consent was obtained from the IRB since the study was retrospective and will use the identified data for analysis. The Uganda National council for science and technology also provided approval. The data retrieved from TASO Mbale treatment centre was kept confidential and patients\u0026rsquo; identity was not retrieved.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Socio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 below shows the socio-demographic characteristics of PLHIV. Four hundred forty two (442) PLHIV underwent through Intensive Adherence Counseling at TASO Mbale for the period Jan 2018 to August 2021. Of these, 361(81.67) aged more than 35 years. The mean age was 45.46 years with standard deviation 13.05 years\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Socio-demographic characteristics of PLHIV receiving treatment at TASO Mbale from Jan 2018 \u0026ndash; August 2021\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e18-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e18.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e81.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; Stdev\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e45.46\u0026plusmn;13.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e65.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e34.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e76.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e23.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment supporter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e37.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e62.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStay together with treatment supporter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e93.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.447574334898277%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.474178403755868%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e06.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 The clinical and behavioral characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe clinical characteristics in this study were the timing of ART initiation, WHO clinical stages of HIV, baseline ART drug regimens, co-infections such as TB and ART regimen after IAC. Meanwhile, the behavioral characteristics were the adherence levels and nutritional status. At the time of ART initiation, 292 (66.06%) of the PLHIV were initiated late on ART, 337(76.24) were at the WHO clinical stage 2 of HIV. On the baseline ART regimen, 140 (31.67%) were on AZT-3TC-NVP and 174(39.37%) were on other 1\u003csup\u003est\u003c/sup\u003e line ART drug regimen not specified in the data. After IAC, 367(83.03%) PLHIV had been switched to TDF/3TC/DTG regimen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Clinical and behavioral characteristics of PLHIV receiving treatment at TASO Mbale from Jan 2018 \u0026ndash; August 2021\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSub-category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTiming of ART initiation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eEarly initiation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e33.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eLate initiation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e66.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO Clinical stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e22.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e76.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline ART Drug Regimen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eABC-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eAZT-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e11.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eAZT-3TC-NVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e31.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eD4T-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eD4T-3TC-NVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e03.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e02.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-NVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e08.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-FTC-NVP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eOther 1\u003csup\u003est\u003c/sup\u003e line Regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e39.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eMissing baseline Regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003ePoor \u0026nbsp;Adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eGood Adherence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e98.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTB status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e97.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e02.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional status/MUAC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eGreen\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e95.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eRed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eYellow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e03.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eART Regimen after IAC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eABC-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e04.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eABC-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eABC/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e03.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eAZT-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eAZT-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eAZT/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e02.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e01.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eTDF/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e83.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.26447574334898%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.413145539906104%\" valign=\"top\"\u003e\n \u003cp\u003eOTHER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.28325508607199%\" valign=\"top\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.039123630672925%\" valign=\"top\"\u003e\n \u003cp\u003e00.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 The proportion of virological suppression and non-suppression of PLHIV after IAC receiving treatment at TASO Mbale Centre between Jan 2018 and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAugust 2021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PLHIV who received IAC were followed for different periods with a total of 13, 428 person-months (PM) of observations. In this follow-up period, a total of 382 (86.4%) were virologically suppressed and their counterparts developed viral load non-suppression 60(13.6%) (Figure 3). Hence, the overall rates of VL suppression was 28.45 (25.70-31.40) and that of VL non-suppression was 4.47 (3.41-5.75) per 1000 person-months (PM) of observation after IAC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Factors associated with non-virological suppression after IAC\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.1 Bivariate analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the bivariate analysis, Cox proportional hazard regression analysis reporting crude Hazard ratio (CHR) for socio-demographics and clinical characteristics of PLHIV; sex, age, residence, treatment supporter availability, staying with treatment supporter, ART regimen, ART adherence level, nutritional status, and clinical stage were all ran independently with VL non-suppression. Five variables emerged to be significantly associated with VL non-suppression that is ART regimen, nutritional status, clinical stage, ART adherence level and client staying with a treatment supporter.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eBivariate analysis for factors associated with viral load non-suppression among adult PLHIV after IAC in eastern region-Uganda from January 2018 to August 2021 (N=442)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eVariable \u0026amp; category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003eTotal (N=442)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003eNon-suppression, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eCHR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e18-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e81(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e15(18.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003e\u0026ge;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e361(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e45(12.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e0.64(0.354-1.147)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e289(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e37(12.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e153(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e23(15.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.33(0.795-2.255)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003ePlace of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e336(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e49(14.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e106(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e11(10.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e0.77(0.397-1.475)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTreatment supporter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e166(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e21(12.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e276(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e39(14.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.27(0.748-2.169)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eStay together with treatment supporter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e413(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e51(12.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e29(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e09(31.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e2.84(1.395-5.794)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.004*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTiming of ART initiation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eEarly initiation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e150(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e21(14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eLate initiation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e292(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e39(13.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e0.74(0.435-1.260)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eWHO Clinical stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eWHO clinical stage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e99(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e13(13.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eWHO clinical stage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e337(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e44(13.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.22(0.656-2.269)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eWHO clinical stage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e05(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e03(60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e3.43(0.948-12.378)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.060*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eWHO clinical stage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e01(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e00(00.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e5.22e-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eAdherence level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eGood Adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e434(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e55(12.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003ePoor \u0026nbsp;Adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e08(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e05(62.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e4.02(1.568-10.304)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.004*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTB status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e431(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e57(13.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e11(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e03(27.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e2.01(0.627-6.433)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eNutritional status/MUAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eGreen\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e422(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e56(13.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eRed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e03(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e01(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e8.59(1.152-63.962)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.036*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eYellow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e17(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e03(17.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.15(0.358-3.706)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.813\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eART Regimen after IAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eABC-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e21(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e06(28.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eABC-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e02(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e00(00.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e6.85e‑19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eABC/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e14(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e03(21.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.25(0.306-5.071)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eAZT-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e06(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e03(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.94(0.479-7.826)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eAZT-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e01(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e01(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e8.62(1.006-73.791)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.049*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eAZT/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e08(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e02(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e2.90(0.565-14.839)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTDF-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e12(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e02(16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e1.00(0.195-4.883)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTDF-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e03(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e01(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e2.75(0.327-23.200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTDF-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e06(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e03(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e3.94(0.963-16.113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.056*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eTDF/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e367(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e39(10.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e0.47(0.198-1.113)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e\u003cem\u003e0.086*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\"\u003e\n \u003cp\u003eOTHER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.384615384615385%\"\u003e\n \u003cp\u003e02(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\"\u003e\n \u003cp\u003e00(00.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.23076923076923%\"\u003e\n \u003cp\u003e6.52e‑19(0 - )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003eStatistical Note: Asterisk (*) p\u0026lt;0.1\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.2 Multivariable analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn multivariable analysis after adjusting for sex, age, residence, treatment supporter availability, staying with treatment supporter, ART regimen, ART adherence level, nutritional status, and clinical stage, two factor variables emerged to be significantly associated with VL non-suppression including ART regimen and ART adherence level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Multivariable analysis for factors associated with viral load non-suppression among adult PLHIV after IAC in eastern region-Uganda from January 2018 to August 2021 (N=442)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable \u0026amp; category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal(N=442)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-suppression, n(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAHR(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eStay together with treatment supporter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e413(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e51(12.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e29(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e09(31.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e2.02(0.893-4.548)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eWHO Clinical stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e99(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e13(13.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e337(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e44(13.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e1.13(0.570-2.220)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e05(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e03(60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e0.63(0.112-3.563)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eWHO clinical stage 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e01(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e00(00.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e8.68e-19(-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eAdherence level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eGood Adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e434(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e55(12.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003ePoor \u0026nbsp; \u0026nbsp; Adherence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e08(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e05(62.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e4.88(1.607-14.836)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0.005***\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eNutritional status/MUAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eGreen\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e422(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e56(13.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eRed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e03(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e01(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e3.12(0.336-29.042)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eYellow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e17(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e03(17.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e0.35(0.065-1.822)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eART Regimen after IAC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eABC-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e21(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e06(28.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003eRef.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eABC-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e02(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e00(00.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e4.48e-19(-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eABC/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e14(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e03(21.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e0.97(0.232-4.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.963\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eAZT-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e06(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e03(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e1.22(0.271-5.496)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.795\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eAZT-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e01(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e01(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e44.70(1.579-1265.056)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0.026**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eAZT/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e08(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e02(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e1.96(0.338-11.396)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-ATV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e12(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e02(16.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e0.86(0.170-4.323)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-EFV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e03(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e01(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e2.71(0.323-22.840)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eTDF-3TC-LPV/r\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e06(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e03(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e5.78(1.137-29.384)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003e0.034**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eTDF/3TC/DTG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e367(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e39(10.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e0.43(0.178-1.048)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.70906200317965%\" valign=\"top\"\u003e\n \u003cp\u003eOTHER\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.149443561208267%\" valign=\"top\"\u003e\n \u003cp\u003e02(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e00(00.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.84737678855326%\" valign=\"top\"\u003e\n \u003cp\u003e1.55e-19(-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.446740858505564%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eStatistical Note: Asterisk (**) p\u0026lt;0.05, ***p\u0026lt;0.01\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e\u003cstrong\u003eThe proportion virological non-suppression among adult PLHIV after IAC\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe virological non-suppression (13.6%) found in the current study is significantly lower than the third UNAIDS set goal of having a viral suppression of 95% on ART[15]. The result from this study is similar with that from Cameroon, where the virological non-suppression was reported at 11.8%[16]. These results are attributed to enhanced education of patient during their treatment visits and IAC.\u003c/p\u003e\n\u003cp\u003eThe finding in this study is inconsistent with results from similar studies conducted in Uganda, Kenya, South Africa and Tanzania (20-32.8%)[10]. This variation may be attributed to the differences in the quality of care in service delivery more so IAC and other adherence support activities[17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with virological non-suppression among PLHIV after IAC at TASO Mbale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study found a significant association between adherence level and HIV virological non-suppression, (AHR=4.88, 95% CI: 1.607-14.836 p=0.005). For example, patients who had Poor adherence level had a five-fold risk of being VL non-suppressed as compared to patients with good adherence levels. This is in agreement of findings of other [10]. Good adherence level has been associated with better virological suppression as well as improved immunological and clinical outcomes[18].\u003c/p\u003e\n\u003cp\u003eThe study further reports a significant association between virological suppression and ART drug regimen after IAC. Whereas there is a variation in drug regimens the NVP-based and the DTG-based regimens. The TDF/3TC/DTG regimen was significantly associated with viral load suppression, AHR=5.78, 95% CI: 1.137-29.384, p=0.034. Patients who were switched to TDF/3TC/DTG ARV regimen were 5.0 times likely to virological loads unsuppressed as compared to those on other ARV regimens. This finding is comparable to another study conducted in Uganda[19]. In general, these finding seem to lend support to the WHO current guidelines as the first ART regimen. The regimen has a higher barrier to resistance compared with NRTIs and NNRTIs-based regimens [10].\u003c/p\u003e\n\u003cp\u003eThis study also indicated that the place of residence of the patients and viral load suppression had no association, meaning that the place of residence whether rural or urban does not in any way significantly affect the viral load suppression. This finding is in agreement with the growing body of literature that provides evidence that location where the patient resides in terms of distance from the treatment centre is not necessarily a barrier that can affect viral load suppression[20].\u003c/p\u003e\n\u003cp\u003eAbout age and virological non-suppression, since the current study was conducted among adults, it is conceivable that adults usually have been on ART for long periods, therefore they suffer medication fatigue and miss appointments leading to poor adherence[21]. Surprisingly, the findings from this study did not show any significant association between age and virological non-suppression. This finding is consistent with those in Kenya[22] and Tanzania[23] who also found no significant association between age and virological non-suppression.\u003c/p\u003e\n\u003cp\u003eThe study found no association between TB co-infection with virological non-suppression, which was also reported in previous studies[19, 24]. The possible explanation to this lack of association could be attributed to the small number of participants diagnosed with TB.\u003c/p\u003e\n\n\u003cp\u003eThe current study did not show a significant association between WHO clinical stages. This is in agreement with another study conducted in Uganda[25]. However, this is inconsistent with a study in Ethiopia[26] that showed increased likelihood of virological non-suppression in WHO clinical stage 2 compared to stage 1. Furthermore, studies in Swaziland[27] and Nigeria[28] found that WHO clinical stages 3 or 4 were significantly associated with virological non-suppression. To explain this variation, in the current study there were very few patients in WHO clinical stages 3 and 4. This might have contributed to no significant association during the analysis in this study.\u003c/p\u003e\n\u003cp\u003e5.3 Strengths and limitations of the study\u003c/p\u003e\n\u003cp\u003eTo the best of the researcher\u0026rsquo;s knowledge, this is the first study to provide up-to-date findings on proportion of virologically non-suppressed PLHIV after IAC and the determinants using TASO Mbale centre program data.\u003c/p\u003e\n\u003cp\u003eNonetheless, this study has some limitations that must be acknowledged. The major limitation was the usage of program data that was not collected for research purposes, which handicapped the researcher as regards the exposure variables that could be studied. The limitation was that the researcher did not analyze variables such marital status, distance from the treatment centre, income levels, education status, occupation, culture and religion. These variables could have concealed socio-demographic confounders because they not routinely collected at the TASO treatment centre. The study is also limited by the fact that it is based on retrospective information provided by the respondents at the time of each visit at the treatment centre which may subject to recall bias. Furthermore, some participants were either lost to follow up, dead or transferred out patients, which might have caused an under or over estimation virological non-suppression.\u003c/p\u003e"},{"header":"5. Conclusion ","content":"\u003cp\u003eIn conclusion, Out of 442 clients with non-suppressed viral load retrieved after IAC, 13.6% did not achieve viral load suppression after IAC. This could be as a result of poor adherence levels to ART. The study revealed that poor adherence to ART was significantly associated with VL non-suppression following IAC. The ART regimen of the patient, especially DTG and AZT based regimen contributed to many clients being able to achieve viral load suppression. Viral load non-suppression was statistically significant to the TDF-3TC-LPV/r ART regimen of the clients. The Socio-demographic and clinical characteristics including; age, sex, treatment supporter, TB status, and nutritional status did not have any significant statistical relationship in VL non-suppression. The virological suppression of PLHIV after IAC is very vital towards the achievement of MoH adopted 95-95-95 targets. To avert the gaps in HIV treatment at regional, national and international levels. We recommend that, there is need to do more drug resistance testing for clients who do not achieve viral load suppression after IAC, all clients who are switched to DTG based regimen and do not achieve viral load suppression will benefit from drug resistance testing and clients with persistent viral load non-suppression should be switched to another regimen after IAC as per the Uganda Ministry of Health guidelines.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e [a short paragraph specifying their individual contributions must be provided]. The following statements should be used \u0026ldquo;Conceptualization, X.X. and Y.Y.; methodology, X.X.; software, X.X.; validation, X.X., Y.Y. and Z.Z.; formal analysis, X.X.; investigation, X.X.; resources, X.X.; data curation, X.X.; writing\u0026mdash;original draft preparation, X.X.; writing\u0026mdash;review and editing, X.X.; visualization, X.X.; supervision, X.X.; funding acquisition, Y.Y. All authors have read and agreed to the published version of the manuscript.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no external funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eIn this section, you should add the Institutional Review Board Statement and approval number, if relevant to your study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u0026nbsp;\u003c/strong\u003e Not applicable for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e I appreciate the support of the statistician and the guidance of my supervisors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNAIDS, \u003cem\u003eUNAIDS. Ending the AIDS epidemic by 2030. Available from: \u003c/em\u003e\u003cem\u003ehttps://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2020.\u003c/li\u003e\n\u003cli\u003eUNAIDS, \u003cem\u003eUNAIDS. 90-90-90: an ambitious treatment target to help end the AIDS epidemic. 2014 [cited 12 April 2023]. Available from: \u003c/em\u003e\u003cem\u003ehttps://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2014.\u003c/li\u003e\n\u003cli\u003eWHO, \u003cem\u003eWorld Health Organization. Antiretroviral therapy and on Pre-Exposure Prophylaxis for HIV. 2015 [cited 12 April 2023]. 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Available from: \u003c/em\u003e\u003cem\u003ehttps://www.unaids.org/en/regionscountries/countries/uganda\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2022.\u003c/li\u003e\n\u003cli\u003eRenju, J., et al., \u003cem\u003e\u0026lsquo;Side effects\u0026rsquo; are \u0026lsquo;central effects\u0026rsquo; that challenge retention in HIV treatment programmes in six sub-Saharan African countries: a multicountry qualitative study.\u003c/em\u003e Sexually transmitted infections, 2017. \u003cstrong\u003e93\u003c/strong\u003e(Suppl 3).\u003c/li\u003e\n\u003cli\u003eWringe, A., et al., \u003cem\u003eBottlenecks to HIV care and treatment in sub-Saharan Africa: a multi-country qualitative study\u003c/em\u003e. 2017, BMJ Publishing Group Ltd.\u003c/li\u003e\n\u003cli\u003eMichie, S., M.M. Van Stralen, and R. West, \u003cem\u003eThe behaviour change wheel: a new method for characterising and designing behaviour change interventions.\u003c/em\u003e Implementation science, 2011. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 1-12.\u003c/li\u003e\n\u003cli\u003eCramer, J.A., et al., \u003cem\u003eMedication compliance and persistence: terminology and definitions.\u003c/em\u003e Value in health, 2008. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 44-47.\u003c/li\u003e\n\u003cli\u003e!!! INVALID CITATION !!! .\u003c/li\u003e\n\u003cli\u003e!!! INVALID CITATION !!! (Cohen et al., 2016; Group, 2015; Okulicz et al., 2015; Rodger et al., 2019; WHO, 2015).\u003c/li\u003e\n\u003cli\u003e!!! INVALID CITATION !!! (Bulage et al., 2017; Bvochora et al., 2019).\u003c/li\u003e\n\u003cli\u003e!!! INVALID CITATION !!! (Bulage et al., 2017; Haberer et al., 2017; Thompson et al., 2012).\u003c/li\u003e\n\u003cli\u003eUPHIA, \u003cem\u003eUganda Population-Based HIV Impact Assessment (UPHIA) 2020-2021.\u003c/em\u003e 2022.\u003c/li\u003e\n\u003cli\u003eUNAIDS., \u003cem\u003eUNAIDS (2021) 2025 aids targets. Ending AIDS epidemic by 2030. Geneva; Joint United Nations Programme on HIV/AIDS. World AIDS Day Report 2020, pp 42\u0026ndash;68, \u003c/em\u003e\u003cem\u003ehttps://doi.org/10.18356/9789210055475c005\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e 2021.\u003c/li\u003e\n\u003cli\u003eDjiyou, A.B., et al., \u003cem\u003eViral load suppression in HIV-infected adolescents in cameroon: towards achieving the UNAIDS 95% viral suppression target.\u003c/em\u003e BMC pediatrics, 2023. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 119.\u003c/li\u003e\n\u003cli\u003eNabukeera, S., et al., \u003cem\u003eFactors associated with virological non-suppression among HIV-positive children receiving antiretroviral therapy at the Joint Clinical Research Centre in Lubowa, Kampala Uganda.\u003c/em\u003e PLoS One, 2021. \u003cstrong\u003e16\u003c/strong\u003e(1): p. e0246140.\u003c/li\u003e\n\u003cli\u003eMartelli, G., et al., \u003cem\u003eAdherence to antiretroviral treatment among children and adolescents in Tanzania: comparison between pill count and viral load outcomes in a rural context of Mwanza region.\u003c/em\u003e PloS one, 2019. \u003cstrong\u003e14\u003c/strong\u003e(3): p. e0214014.\u003c/li\u003e\n\u003cli\u003eAgegnehu, C.D., M.W. Merid, and M.K. Yenit, \u003cem\u003eIncidence and predictors of virological failure among adult HIV patients on first-line antiretroviral therapy in Amhara regional referral hospitals; Ethiopia: a retrospective follow-up study.\u003c/em\u003e BMC Infectious Diseases, 2020. \u003cstrong\u003e20\u003c/strong\u003e(1): p. 1-14.\u003c/li\u003e\n\u003cli\u003eSahay, S., K.S. Reddy, and S. Dhayarkar, \u003cem\u003eOptimizing adherence to antiretroviral therapy.\u003c/em\u003e The Indian journal of medical research, 2011. \u003cstrong\u003e134\u003c/strong\u003e(6): p. 835.\u003c/li\u003e\n\u003cli\u003e!!! INVALID CITATION !!! (Desta et al., 2020; Jobanputra et al., 2015).\u003c/li\u003e\n\u003cli\u003eMwangi, A. and B. van Wyk, \u003cem\u003eFactors associated with viral suppression among adolescents on antiretroviral therapy in Homa Bay County, Kenya: a retrospective cross-sectional study.\u003c/em\u003e HIV/AIDS-Research and Palliative Care, 2021: p. 1111-1118.\u003c/li\u003e\n\u003cli\u003eMuri, L., et al., \u003cem\u003eDevelopment of HIV drug resistance and therapeutic failure in children and adolescents in rural Tanzania: an emerging public health concern.\u003c/em\u003e AIDS (London, England), 2017. \u003cstrong\u003e31\u003c/strong\u003e(1): p. 61.\u003c/li\u003e\n\u003cli\u003eNegash, H., et al., \u003cem\u003eIncreased virological failure and determinants among HIV patients on highly active retroviral therapy in Adigrat General Hospital, Northern Ethiopia, 2019: hospital-based cross-sectional study.\u003c/em\u003e Infection and Drug Resistance, 2020: p. 1863-1872.\u003c/li\u003e\n\u003cli\u003eNatukunda, J., et al., \u003cem\u003eVirologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study.\u003c/em\u003e Tropical medicine and health, 2019. \u003cstrong\u003e47\u003c/strong\u003e(1): p. 1-10.\u003c/li\u003e\n\u003cli\u003eDesta, A.A., et al., \u003cem\u003eHIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study.\u003c/em\u003e BMC infectious diseases, 2020. \u003cstrong\u003e20\u003c/strong\u003e: p. 1-10.\u003c/li\u003e\n\u003cli\u003eJobanputra, K., et al., \u003cem\u003eFactors associated with virological failure and suppression after enhanced adherence counselling, in children, adolescents and adults on antiretroviral therapy for HIV in Swaziland.\u003c/em\u003e PloS one, 2015. \u003cstrong\u003e10\u003c/strong\u003e(2): p. e0116144.\u003c/li\u003e\n\u003cli\u003eGreig, J.E., et al., \u003cem\u003ePredictors of raised viral load during antiretroviral therapy in patients with and without prior antiretroviral use: a cross-sectional study.\u003c/em\u003e PLoS One, 2013. \u003cstrong\u003e8\u003c/strong\u003e(8): p. e71407.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Virological, non-suppression, Intensive Adherence Counseling, adult PLHIV, facotors ","lastPublishedDoi":"10.21203/rs.3.rs-3975082/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3975082/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e According to the Joint United Nations Program (JUNP) on HIV/AIDS through the ambitious 95-95-95 target, 95% of people living with HIV (PLHIV) on antiretroviral treatment (ART) should be virally suppressed. Viral load (VL) non-suppression has been found to be associated with ART adherence, and intensive adherence counseling (IAC) has been shown to lead to VL re-suppression by over 70% in PLHIV on ART. Although Uganda has employed the IAC intervention program since 2015, there is paucity of research data on HIV viral load non-suppression after IAC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e This was a Cross-sectional study, conducted in TASO Mbale. Data were abstracted for all clients with non-suppressed viral load between Jan 2018 to August 2021 from the TASO Mbale program database and various parameters were considered. These parameters included the IACs done, the repeat VL done, presence of an opportunistic infection, sex, age, and the current regimen. A client was considered to have a non-virological status if there were \u0026gt;1000 copies of CD4 cells. The clients were followed for a maximum period of 43 months. A total of 13428 person months was observed for different periods. The data were then analyzed using statistical software Stata version 14. Bivariate analysis was done for all covariates. Hazard ratios (HRs) were estimated as a degree of association between viral non-suppression and client features, via a Cox proportional hazards regression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 442 PLHIV after IAC were enrolled, of whom 60 (13.6%) had VL non suppression following IAC. The overall rate of VL non-suppression was 4.47 (3.41-5.75) per 1000 person-months (PM) of observation after IAC. ART regimen was statistically significant with viral load suppression especially DTG-3TC-LPV/r based regimen had (AHR=5.78, 95%CI, 1.137-29.384, p=0.034). Poor adherence level to ART had significant contribution to viral load non-suppression (AHR=4.88, 95%CI: 1. 607-14.836, p=0.005).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Virological non-suppression after IAC was found at 13.6% and associated with patients’ poor adherence level. Viral load suppression was associated with DTG-3TC-LPV/r and AZT-3TC-LPV/r based regimens. The findings lend a huge boost towards the third UNAIDS target of 95%.\u003c/p\u003e","manuscriptTitle":"Factors associated with Virological non-suppression among adult PLHIV after receiving Intensive Adherence Counseling at Taso Mbale, Eastern Uganda: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-23 18:44:58","doi":"10.21203/rs.3.rs-3975082/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"15e3198a-a9fe-4507-9ab1-62492731c689","owner":[],"postedDate":"February 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-01T15:46:34+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-23 18:44:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3975082","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3975082","identity":"rs-3975082","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}