When patients fail UNAIDS’ last 90 ‐ the “failure cascade” beyond 90‐90‐90 in rural Lesotho, Southern Africa: a prospective cohort study

• DOI: 10.7448/ias.20.1.21803
• Publication Date: 2017-07-27T23:13:34Z
• Authors: Niklaus Daniel La...; Isaac Ringera; Thabo Ishmael Lejone; Molisana Cheleboi; Sarah Wagner; Josephine Muhairwe; Thomas Klimkait
• Keywords: Attendance

HIV-infected individuals on first-line antiretroviral therapy (ART) in resource-limited settings who do not achieve the last "90" (viral suppression) enter a complex care cascade: enhanced adherence counselling (EAC), repetition of viral load (VL) and switch to second-line ART aiming resuppression. This study describes "failure cascade" patients Lesotho.Patients aged ≥16 years at 10 facilities rural Lesotho received first-time VL June 2014. Those with ≥80 copies/mL were included cohort. The cascade was assessed four points: attendance EAC, result follow-up after case sustained unsuppressed outcome 18 months initial VL. Multivariate logistic regression used assess predictors being retained resuppression follow-up.Out 1563 underwent VL, 138 (8.8%) had Out these, 124 (90%) attended EAC 116 (84%) (4 died, 2 transferred out, 11 lost, 5 switched before VL). Among 36 (31%) achieved 80 58 second-line, remaining continued first line. At months' December 2015, out initially 56 (41%) virally suppressed, 37 (27%) 45 (33%) dead, another clinic or without documented Achieving (adjusted odds ratio (aOR): 5.02; 95% confidence interval: 1.14-22.09; p = 0.033) viremia (aOR: 7.17; 1.90-27.04; 0.004) associated suppressed follow-up. Age, gender, education, time level associated.In this Lesotho, outcomes along poor. To improve vulnerable patient group fails "90", programmes need focus timely second line for cases continuous despite EAC.