Assessing community barriers exacerbating viral non-suppression in children living with HIV (CLHIV) in Mangochi, Malawi
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Malawi AIDS Counseling and Resource Organization (MACRO), Malawi
Malawi AIDS Counseling and Resource Organization (MACRO), Lilongwe, Malawi
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A769
Background: According to the National HIV/AIDS policy 2022-2027, Malawi achieved the 90:90:90 treatment targets in 2020 and is on course towards achieving 95:95:95 targets by 2025. This means viral suppression must in the least be at 95% among HIV positive clients. Though remarkable progress has been made towards HIV mitigation and prevention clinically, community barriers have stalled progress by invigorating poor ART adherence and/or treatment failure. The aim of this study was to identify and mitigate the root causes of high viral load in CLHIV in Mangochi district. Methods: A cohort of 2146 CLHIV with an initial suppression rate of 73% (1566) was enrolled under a case management program and assessed at household level to establish the factors that affect their adherence to ART. Standard questionnaires were administered and analysis was done using DHIS2. Results: The assessment revealed factors such as parental neglect, misleading religious counsel, food shortages, long distances to health facilities and sharing of medication with other HIV positive clients as some of the underlying causes of viral non-suppression in CLHIV. The program responded with interventions such as case conferences, identification of treatment supporters, provision of nutritional support and transport support to needy clients, active viral load tracking, frequent household visits and virtual reminders via phone calls. As a result, an additional 148 CLHIV attained viral suppression to bring the total number of CLHIV with suppressed viral load to 1714 (80%) within six months. Conclusions: Clinical support provided to CLHIV in health-facilities is insufficient to achieve viral suppression. A coordinated approach with community structures is required to ensure CLHIV receive a continuum of care in their communities to achieve viral suppression as part of epidemic control.
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