A multinomial modelling of the factors that impact viral load levels in adults on anti-retroviral therapy in Namibia

A case study of Nankudu Health District

Abstract

Namibia is one of the Sub-Saharan Africa countries still hit with the Human Immunodeficiency Virus (HIV), with a 12.6% HIV prevalence among adults aged 15-64 years, and with the Kavango West region of Namibia still having a 12.1% HIV infection prevalence. As a prevention in combating new HIV infections, viral load suppression is crucial, especially during the application of HIV treatment. In this paper, the multinomial logit regression model was used to statistically examine the impacting factors of Anti-Retroviral Therapy (ART) adult patients’ viral load levels using data collected from the Nankudu health district. Results showed that majority of the patients had never been testing for Hepatitis B, regardless of their viral load levels, while patients’ characteristics such as age, sex, marital status, ART duration, tuberculosis (TB) screening, hepatitis B screening, ART adherence and ART status had a significant impact on the patients’ viral load levels. In addition, ART patients who were less than 20 years old and had been on ART between 4 to 15 years were more likely to have an undetectable viral load, while those who had been on ART between 7 to 15 years were less likely to have a virologic failure. Also, patients who were never tested for hepatitis B were more likely to have a virologic failure, while those who tested positive for TB were less likely to have an undetectable viral load. It is therefore recommended that the Namibian government and policy makers consider making hepatitis B screening mandatory, especially, among HIV patients and ART patients. Moreover, periodic viral load testing to monitor responses to ART is important and needs to be conducted to prevent progression of patients to virologic failure and drug resistance.