Hiv viral suppression rate at enrolment, status at one year, and associated factors to non-suppression among outpatient adults at 19 hospitals in indonesia

Intro: HIV-RNA viral load (VL) testing is not widely accessible in Indonesia because of the availability and cost. Research on viral suppression has been limited. We assessed the rate and factors associated with VS among HIV-infected adults on antiretroviral therapy (ART) for >6 months in 19 hospitals across Indonesia and reported their one-year follow-up status. Methods: Data from a cohort of consenting HIV outpatients enrolled between Jan 2018-Jun 2020 were evaluated at the time of enrolment. We looked at socio- demographic, clinical and therapeutic characteristics among adults on ART for >6 months. Factors with p-value of <0.1 in univariate analysis were added to the multivariable and assessed with logistic regression. The status at one year was determined using data on VL and mortality at month-12 follow up. Findings: The analysis comprised 3,182/4,147 (76.7%) adults; of whom 2,157(67.8%) were male, 1,397 (43.9%) were between 31-40 years old, and 1,735 (54.5%) acquired HIV through heterosexual contact. VS rate was 2,877 (90.4%; 95% CI: 89.3-91.4%). Non-VS was significantly associated with younger age of 18-30 years (adjusted OR (aOR) 1.63; 95% CI 1.06-2.5), 31-40 years (aOR 1.81; 95% CI 1.27-2.58), WHO clinical stage III-IV at HIV diagnosis (aOR 1.92; 95% CI 1.36-2.71), CD4 increased by ≥50 cells/mL from first measurement (aOR 0.1; 95% CI 0.07-0.14), ever having changed ART (aOR 1.56; 95% CI 1.15-2.11), and on second line ART (aOR 9.61; 95% CI 5.37-17.21). At month-12, sustained VS was observed in 2,733/2,913 (93.8%), while mortality was significantly lower in VS compared to non-VS[14 (0.5%; 95% CI 0.3-8.20%) vs. 39 (12.8%; 95% CI 9.3- 17.1%)]. Conclusion: A substantial proportion of HIV-infected adults on >6 months ART in Indonesia had been and remained suppressed after 12 months. Several factors and higher mortality were associated with non-VS. Improvement from first CD4 measurement might still be useful to predict VS in resource-limited setting.