Introduction In Central-African Republic, according to UNAIDS in 2019, out of approximately 100,000 people living with HIV, 70% (72,000) knew their HIV status and 47,000 (46%) were on ARV therapy; however, there is a paucity of data on viral load suppression in people on ARV therapy. The objective of this study was to assess the third 90 of the UNAIDS strategy for the years 2019 and 2020 in the CAR. Methods We analyzed the available viral load data extracted from the data base of the medical analysis laboratory (SYSLAM) of the Institut Pasteur of Bangui for the years 2019 and 2020. The viral loads were determined based on plasma collected in an EDTA tube with Cepheid’s GeneXpert® 16-module controllers. Viral load data were extracted from SYSLAM, converted to Excel format, and analyzed with STATA version 14 software. The significance threshold for the statistical tests was set at 5%. Results This study included 22,895 patients, of who 72% were female. The average age was 40.82 years, and the majority of the patients (80%) came from the city of Bangui. Regarding the virological parameters associated with this study, 66% of the patients had significant viral load suppression according to the WHO recommendations and 34% were in virological failure. Patients over 50 years of age (71.85%) and age group 40 - 49 years (69.25%) recorded significant levels of viral load suppression. On the other hand, 63.45% of patients under 18 years of age had virological failure. All of these results were statistically significant (p < 0.005). Conclusion There should be a concerted effort, to make viral load accessible and available to all patients receiving ARV treatment in the CAR and the management of HIV/AIDS infection of children and adolescents should be given special attention.
References
[1]
UNAIDS (2014) 90-90-90. An Ambitious Treatment Target to Help End the AIDS Epidemic. Joint United Nations Programme on HIV/AIDS. Geneva.
[2]
République centrafricaine. https://www.unaids.org/fr/regionscountries/countries/centralafricanrepublic
[3]
Nyasenu, Y.T., Farra, A., Djorie, S.G., Yambiyo, B.M., Manirakiza, A., Ngaya, G.S., Moussa, S., Pelembi, P., Golongba, D.M., Bere, A., Mambely-Nzako, R., Mandeng, M.-J., Berlioz-Arthaud, A., Rubbo, P.-A. and Lombart, J.-P. (2018) Trends of HIV Viral Load in Patients under Combined Antiretroviral Treatment in Bangui, Central African Republic. World Journal of AIDS, 8, 53-62. https://doi.org/10.4236/wja.2018.82005
[4]
Ehrenkranz, P., Rosen, S., Boulle, A., Eaton, J.W., Ford, N., Fox, M.P., Grimsrud, A., Rice, B.D., Sikazwe, I. and Holmes, C.B. (2021) The Revolving Door of HIV Care: Revising the Service Delivery Cascade to Achieve the UNAIDS 95-95-95 Goals. PLOS Medicine, 18, e1003651. https://doi.org/10.1371/journal.pmed.1003651
[5]
Glass, T.R., Motaboli, L., Nsakala, B., Lerotholi, M., Vanobberghen, F., Amstutz, A., Lejone, T.I., Muhairwe, J., Klimkait, T. and Labhardt, N.D. (2019) The Viral Load Monitoring Cascade in a Resource-Limited Setting: A Prospective Multicentre Cohort Study after Introduction of Routine Viral Load Monitoring in Rural Lesotho. PLoS ONE, 14, e0220337. https://doi.org/10.1371/journal.pone.0220337
[6]
Ceffa, S., Luhanga, R., Andreotti, M., Brambilla, D., Erba, F., Jere, H., Mancinelli, S., Giuliano, M., Palombi, L. and Marazzi, M.C. (2016) Comparison of the Cepheid GeneXpert and Abbott M2000 HIV-1 Real Time Molecular Assays for Monitoring HIV-1 Viral Load and Detecting HIV-1 Infection. Journal of Virological Methods, 229, 35-39. https://doi.org/10.1016/j.jviromet.2015.12.007
[7]
Gous, N., Scott, L., Berrie, L. and Stevens, W. (2016) Options to Expand HIV Viral Load Testing in South Africa: Evaluation of the GeneXpert® HIV-1 Viral Load Assay. PLoS ONE, 11, e0168244. https://doi.org/10.1371/journal.pone.0168244
[8]
Villa, G., Abdullahi, A., Owusu, D., Smith, C., Azumah, M., Sayeed, L., Austin, H., Awuah, D., Beloukas, A., Chadwick, D., Phillips, R. and Geretti, A.M. (2020) Determining Virological Suppression and Resuppression by Point-of-Care Viral Load Testing in a HIV Care Setting in Sub-Saharan Africa. EClinicalMedicine, 18, Article ID: 100231. https://doi.org/10.1016/j.eclinm.2019.12.001
[9]
Sacks, J.A., Fong, Y., Gonzalez, M.P., Andreotti, M., Baliga, S., Garrett, N., Jordan, J., Karita, E., Kulkarni, S., Mor, O., Mosha, F., Ndlovu, Z., Plantier, J.C., Saravanan, S., Scott, L., Peter, T., Doherty, M. and Vojnov, L. (2019) Performance of Cepheid Xpert HIV-1 Viral Load Plasma Assay to Accurately Detect Treatment Failure. AIDS, 33, 1881-1889. https://doi.org/10.1097/QAD.0000000000002303
[10]
Moyo, S., Mohammed, T., Wirth, K.E., Prague, M., Bennett, K., Holme, M.P., Mupfumi, L., Sebogodi, P., Moraka, N.O., Boleo, C., Maphorisa, C.N., Seraise, B., Gaseitsiwe, S., Musonda, R.M., van Widenfelt, E., Powis, K.M., Gaolathe, T., Tchetgen Tchetgen, E.J., Makhema, J.M., Essex, M., Lockman, S. and Novitsky, V. (2016) Point-of-Care Cepheid Xpert HIV-1 Viral Load Test in Rural African Communities Is Feasible and Reliable. Journal of Clinical Microbiology, 54, 3050-3055. https://doi.org/10.1128/JCM.01594-16
[11]
(2018) Directives nationales sur l’utilisation des antirétroviraux pour la prévention et le traitement de l’infection a VIH en République Centrafricaine. 4th Edition.
[12]
Wakooko, P., Gavamukulya, Y. and Wandabwa, J.N. (2020) Viral Load Suppression and Associated Factors among HIV Patients on Antiretroviral Treatment in Bulambuli District, Eastern Uganda: A Retrospective Cohort Study. Infectious Diseases, 13, 1178633720970632. https://doi.org/10.1177/1178633720970632
[13]
Euvrard, J., Schulz, T., Hilderbrand, K., Bosland, M., Osler, M., Boulle, A. and Davies, M.A. (2019) How Accurately do Routinely Reported HIV Viral Load Suppression Proportions Reflect Progress towards the 90-90-90 Target in the Population on Antiretroviral Treatment in Khayelitsha, South Africa. South African Medical Journal, 109, 174-177. https://doi.org/10.7196/SAMJ.2019.v109i3.13456
[14]
Elgalib, A., Shah, S., Al-Habsi, Z., et al. (2018) HIV Viral Suppression in Oman: Encouraging Progress toward Achieving the United Nations “Third 90”. International Journal of Infectious Diseases, 71, 94-99. https://doi.org/10.1016/j.ijid.2018.04.795
[15]
Ross, J., Ribakare, M., Remera, E., Murenzi, G., Munyaneza, A., Hoover, D.R., Shi, Q., Nsanzimana, S., Yotebieng, M., Nash, D., Anastos, K. and Central Africa IeDEA (2020) High Levels of Viral Load Monitoring and Viral Suppression under Treat All in Rwanda—A Cross-Sectional Study. Journal of the International AIDS Society, 23, e25543. https://doi.org/10.1002/jia2.25543
[16]
Haas, A.D., Radin, E., Hakim, A.J., Jahn, A., Philip, N.M., Jonnalagadda, S., Saito, S., Low, A., Patel, H., Schwitters, A.M., Rogers, J.H., Frederix, K., Kim, E., Bello, G., Williams, D.B., Parekh, B., Sachathep, K., Barradas, D.T., Kalua, T., Birhanu, S., Justman, J., et al. (2020) Prevalence of Nonsuppressed Viral Load and Associated Factors among HIV-Positive Adults Receiving Antiretroviral Therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): Results from Population-Based Nationally Representative Surveys. Journal of the International AIDS Society, 23, e25631. https://doi.org/10.1002/jia2.25631
[17]
Hermans, L.E., Carmona, S., Nijhuis, M., Tempelman, H.A., Richman, D.D., Moorhouse, M., Grobbee, D.E., Venter, W.D.F. and Wensing, A.M.J. (2020) Virological Suppression and Clinical Management in Response to Viremia in South African HIV Treatment Program: A Multicenter Cohort Study. PLOS Medicine, 17, e1003037. https://doi.org/10.1371/journal.pmed.1003037
[18]
Hayes, R.J., Donnell, D., Floyd, S., Mandla, N., Bwalya, J., Sabapathy, K., Yang, B., Phiri, M., Schaap, A., Eshleman, S.H., Piwowar-Manning, E., Kosloff, B., James, A., Skalland, T., Wilson, E., Emel, L., Macleod, D., Dunbar, R. and Simwinga, M. (2019) Effect of Universal Testing and Treatment on HIV Incidence HPTN 071 (PopART). New England Journal of Medicine, 381, 207-218. https://doi.org/10.1056/NEJMoa1814556
[19]
Huerga, H., Van Cutsem, G., Ben Farhat, J., Puren, A., Bouhenia, M., Wiesner, L., Dlamini, L., Maman, D., Ellman, T. and Etard, J.F. (2018) Progress towards the UNAIDS 90-90-90 Goals by Age and Gender in a Rural Area of KwaZulu-Natal, South Africa: A Household-Based Community Cross-Sectional Survey. BMC Public Health, 18, 303. https://doi.org/10.1186/s12889-018-5208-0
[20]
Mburu, M., Guzé, M.A., Ong’wen, P., Okoko, N., Moghadassi, M., Cohen, C.R., Bukusi, E.A. and Wolf, H.T. (2019) Evaluating the Effectiveness of the HIV Adolescent Package of Care (APOC) Training on Viral Load Suppression in Kenya. Public Health, 173, 146-149. https://doi.org/10.1016/j.puhe.2019.05.026
[21]
Zanoni, B.C., Sibaya, T., Cairns, C., Lammert, S. and Haberer, J.E. (2017) Higher Retention and Viral Suppression with Adolescent-Focused HIV Clinic in South Africa. PLoS ONE, 12, e0190260. https://doi.org/10.1371/journal.pone.0190260
[22]
Selon l’OMS, l’accès aux médicaments contre le VIH est gravement perturbé par la COVID-19 alors que la riposte au sida ne progresse plus. https://www.who.int/fr/news/item/06-07-2020-who-access-to-hiv-medicines-severely-impacted-by-covid-19-as-aids-response-stalls
[23]
Leçons Tirées de la Riposte au VIH: l’ONUSIDA Avertit des Dangers liés au Non-Respect des Droits Humains au Cours de la Riposte à la COVID-19. https://www.unaids.org/fr/resources/presscentre/pressreleaseandstatementarchive/2020/august/20200827_rights-in-a-pandemic
