Community-based enhanced adherence counseling among people living with HIV in Ethiopia: outcomes and key predictors of viral suppression.

ABSTRACT:

Background

Community-based enhanced adherence counseling (CEAC) is person-centered intervention provided to PLHIV on ART and with unsuppressed viral load (VL) in community settings. This study assessed the effectiveness of CEAC in achieving viral load suppression (VLS) and explored key predictors to inform scalable strategies in resource-limited settings.

Methods

A quantitative, retrospective follow-up study was conducted between October 2022 and October 2024 on 2839 PLHIVs enrolled to CEAC service. Study participants were HIV-infected individuals who were on ART for at least six months and had unsuppressed VL. Frontline community health workers provided them with three-to-six monthly sessions of counseling to address underlying barriers to treatment adherence. Client-level data were collected using CommCare mobile app and analyzed in SPSS.

Results

A total of 2839 PLHIV were enrolled in CEAC, of which 2365 (83.3%; 95% CI: 82.0-84.5%) clients achieved VLS after receiving three-to-six months of CEAC. Major significant predictors of VLS included age 1-14 years [AOR (95% CI) = 2.08 (1.25-3.41)], having a baseline VL of < 10,000 copies/mL [AOR (95% CI) = 1.75 (1.41-2.17)], and enrolled to other community-based case management services [AOR (95% CI) = 5.77 (4.33-7.71)]. Moreover, PLHIV with adherence related challenges resolved had higher odds of VLS [AOR = 1.86; 95%CI: 1.48 - 2.34].

Conclusion

CEAC service demonstrated encouraging results in supporting VLS among PLHIVs on ART with unsuppressed VL count. Community-based interventions showed potential in addressing individual barriers that were challenging to health facility to improve VLS. We recommend continuing efforts to scale up and integrate CEAC with ongoing health facility EAC services to synergistically improve VLS and accelerate epidemic control.

SUBMITTER: Ebrahim ES 

PROVIDER: S-EPMC12604243 | biostudies-literature | 2025 Nov

REPOSITORIES: biostudies-literature