Factors Associated with ART Adherence and Viral Load Suppression Among Persons Living with HIV in Likasi, Democratic Republic of Congo

The 90-90-90 UNAIDS targets to measure the progress toward HIV control were not achieved globally in 2020, with significant differences between countries. Many low- and middle-income countries in sub-Saharan Africa, including the DRC, had the worst outcomes. These target shortfalls, especially in viral load suppression, suggest continued HIV transmission, mortality, and morbidity. Several factors have been found to influence viral load suppression. This study sought to determine the patient and facility factors associated with adherence to ART and viral load suppression among people living with HIV. A cross-sectional study was carried out in 2021 among 367 adult HIV patients receiving ART in health facilities in Likasi. Adherence to ART was measured using self-reports and was categorized as adherent or non-adherent. Viral load level was the most recently measured value, and viral load suppression was defined using the 1000 copies/mL WHO cut-off. Data analysis was done using SAS software. Frequency and percentage were used to describe the sample; Chi Square determined the patient and facility factors associated with 1) adherence to ART and 2) viral load suppression; Odds ratios determined the strength of the associations. The results showed suboptimal levels of adherence to ART (82%) and viral load suppression (74%). Adherence was most likely among patients who 1) disclosed their status, 2) were in health facilities of > 459 patients, and 3) were in health facilities with very good hospitality. Adherence was less likely among patients 1) who disclosed to their partners, 2) who were in secondary-level facilities, and 3) in Kikula health zone. The likelihood of suppressing viral load was higher in adherent patients and those who disclosed their HIV status. Subjects with an NGO support group and those from a secondary-level facility were less likely to suppress their viral load. Conclusions: Likasi is behind in achieving the UNAIDS viral load suppression goal. Several factors impact ART adherence and viral load suppression. The health system management, policymakers, and practitioners could target these factors for improvement and contribute to achieving the 95-95-95 UNAIDS targets. This first assessment of the factors associated with ART adherence and viral load suppression in Likasi fills the existing literature gap and calls for further studies.