2. Immunologic and virological response to ART among HIV infected individuals at a tertiary hospital in Ghana
¹Obiri-Yeboah Dorcas, School of Medical Sciences, University of Cape Coast
2Ibrahim Baidoo, Public Health Unit, Cape Coast Teaching Hospital
3Arthur Francis, Cape Coast Teaching Hospital
4Hayfron-Benjamin Anna, School of Nursing, University of Cape Coast, Ghana
5Ayisi-Addo Stephen, National AIDS/STI Control Program, Ghana

3. Outline Background Aim and objectives Methods Results
Discussion and Conclusion

4. Background- WHO “90 90 90” policy
90% of infected people should know their status
90% of infected people should be on ART
90% on ART should achieve virological suppression by 12 months

5. Treatment failure
Viral loads persistently more than 1000 copies of HIV RNAs/ml of blood plasma after 12 months on ART
and/or
Immunologically when CD4 counts are persistently at or below 250 cells/mm3
(ART Guideline, 2016)

6. Study aim
To analyze the determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Ghana.

7. Methods
Design: analytical cross sectional study with a retrospective component
Location: Cape Coast Teaching Hospital (CCTH) ART Centre
Participants: Clients aged ≥18 years on ART for ≥6 months
Sampling strategy: systematic (1: 3) sampling
Total participants: 440
Data collection: client records, questionnaire and laboratory tests

8. Results Variable Mean (SD)/n (%) Age (yrs.) Mean 45.5 (±11.6) 18-30
38 (8.6)
31-60
367 (83.4)
>60
35 (8.0)
Gender
Male
94 (21.4)
Female
346 (78.6)
HIV type 1
432 (98.1)
1 & 2
8 (1.8)
tuberculosis
Yes
13 (2.9) No
427 (97.1)

9. Virological response

10. Immunological response

11. Associated factors Variable CD4 <350, {n (%)} OR (95%CI) P value
*aOR (95%CI)
Employment
Unemployed
34 (19.7) -
Unskilled employment
129 (74.6)
0.6 ( )
0.04
0.6 ( )
0.16
Skilled employment
10 (5.8)
0.4 ( )
0.09
0.2 ( )
0.01
Tuberculosis Diagnosis No
165 (95.4)
Yes
8 (4.6)
2.4 ( )
0.15
8.5 ( )
0.05
Plasma viral load after 6 mths on ART (N=139)
≤1000 copies/ml
53 (38.1)
>1000 copies/ml
86 (61.9)
2.2 (1.4 – 3.6)
0.001
2.0 ( )

12. Discussion/Recommendations
6 months and 12 months on ART, participants who had viral copies <1000/ml rose from 149 (47.0%) to 368 (89.5%) respectively.
Mean CD4 count rose from cells/mm3, cells/mm3, and cells/mm3
“Treat All” policy and early ART initiation recommended to improve outcome (WHO, 2017)
Quality monitoring and routine VL testing is essential at all levels

13. Associated factors
Poor response associated with TB- screening and treatment will improve ART response (Soeters et al. 2014)
Other factors which affect adherence to ART needs to be explored to improve outcome (Elul et al. 2013)
Employment situation
Gender
Disclosure to sexual partners (Obiri-Yeboah et al. 2016)
Age etc

14. Conclusion
Strict adherence to the national policy on HIV testing, management of positive clients and full implementation of the “Treat All” policy in Ghana could achieve, if nothing at all, the third “90, 90, 90” target by 2020.

15. References
Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. WHO (2017). Geneva
Guidelines for Antiretroviral Therapy in Ghana. (2016). National AIDS Control Programme, Accra Ghana,
Soeters, H. M., S. Napravnik, M. R. Patel, J. J. J. Eron and A. Van Rie (2014). "The effect of tuberculosis treatment on virologic and CD4+ cell count response to combination antiretroviral therapy: a systematic review." AIDS 28(2):

16. Obiri-Yeboah. D, Amoako-Sakyi. D, Baidoo. I, Adu-Oppong. A and R
Obiri-Yeboah. D, Amoako-Sakyi. D, Baidoo. I, Adu-Oppong. A and R. T (2016). "The ‘Fears’ of Disclosing HIV Status to Sexual Partners: A Mixed Methods Study in a Counseling Setting in Ghana." AIDS and Behavior.
Elul, B., P. Basinga, H. Nuwagaba-Biribonwoha, S. Saito, D. Horowitz, D. Nash, J. Mugabo, V. Mugisha, E. Rugigana, R. Nkunda and A. Asiimwe (2013). "High levels of adherence and viral suppression in a nationally representative sample of HIV-infected adults on antiretroviral therapy for 6, 12 and 18 months in Rwanda." PLoS One 8(1): e53586.

17. Thank you