Clinical Outcomes and Role of Non-adherence in Immediate Antiretroviral Therapy Among Persons Living With Hiv - Attending Kemri Ccc, Nairobi Kenya

Abstract

Introduction: The greatest burden of HIV is experienced in low and middle-income countries (LMIC), particularly in sub-Saharan Africa, which is home to more than two-thirds of all people living with HIV worldwide. The World Health Organization's (WHO) "Test and Treat all" guidance of September 2015 aimed to prevent illness and death among people living with HIV and avert new infections by reducing onward HIV transmission. This has been recognized as the primary strategy for achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90‐90‐90 targets. By 2019, Kenya Test and Treat had been adopted in >95% of the ART treatment sites. Further, in 2019 Kenya adopted the WHO new first-line ART recommendations comprising Tenofovir/Lamivudine/Dolutegravir - TDF + 3TC + DTG. Despite these efforts, new HIV infections and AIDS‐related mortality remain higher in developing countries, including Kenya. The clinical outcome of this model and the new ART regimen has not been evaluated in Kenya. Objectives: This longitudinal study evaluated the immunological, virologic, hematological, and blood chemistry changes three and six months into ART treatment on the TDF+3TC+DTG regimen. It also evaluated the role of patients' ART adherence on clinical outcomes. Materials and Methods: This longitudinal enrolled 141 patients living with HIV initiating TDF + 3TC + DTG at Family AIDS Care and Education Services (FACES) program, based at the Center for Respiratory Disease Research (CRDR) Kenya Medical Research Institute (KEMRI), Nairobi and followed them up for six months. At baseline, month 3 and 6-time points, 5ml blood samples were collected, and structured interviews using an HIV treatment adherence tool was used to gather patient social and demographic information. The CD4, HIV viral load, complete blood count, ALT, AST and creatinine was determined following manufacturers’ instructions. Descriptive statistics were used to analyze patient characteristics and laboratory parameters, with continuous variables assessed for outliers and illogical values flagged and corrected by checking patient records. STATA v 13 was used for statistical analysis, on-parametric Wilcoxon t-test was used to assess variations in CD4 cells, viral load, hematological parameters, and hepatic enzymes at 3- and 6-months post-ART initiation. Correlation analysis was also performed to determine the relationship between non-adherence and hematological parameters, hepatic enzymes, CD4, and viral load. The findings were presented in tables, line graphs, histograms, and box plots....................................................