Identifying care gaps along the HIV treatment failure cascade: A multistate analysis of viral load monitoring, re-suppression, and regimen switches in Zambia
After treatment failure, we identified substantial delays in returning for adherence counseling, treatment interruptions, and missed opportunities in rechecking VL status or switching to second-line therapy in routine care in Zambia. Among those who did have VL tests rechecked, re-suppression rates were significantly higher among individuals on TLD compared to TLE. To optimize response and outcomes after treatment failure, strategies must prioritize and target both client and health systems behaviors to meet the care needs in the modern era of TLD.
Authors
- Jacob Mutale (ORCID: https://orcid.org/0000-0002-8914-0645)
- Brian Rice (ORCID: https://orcid.org/0000-0002-5416-8058)
- Laura K. Beres (ORCID: https://orcid.org/0000-0002-4731-7828)
- Alison Wringe (ORCID: https://orcid.org/0000-0001-6939-3461)
- Noelle Le Tourneau (ORCID: https://orcid.org/0000-0002-8906-6879)
- Njekwa Mukamba (ORCID: https://orcid.org/0000-0002-5757-6858)
- Izukanji Sikazwe (ORCID: https://orcid.org/0000-0002-3898-2607)
- Elvin Geng (ORCID: https://orcid.org/0000-0002-0825-1424)
- Sandra Simbeza (ORCID: https://orcid.org/0000-0002-0150-3369)
- Jake M. Pry (ORCID: https://orcid.org/0000-0001-6312-4420)
- Aaloke Mody (ORCID: https://orcid.org/0000-0003-3787-365X)
- Anjali Sharma (ORCID: https://orcid.org/0000-0002-8189-0732)
- Kombatende Sikombe (ORCID: https://orcid.org/0000-0002-8187-8661)
- Carolyn Bolton‐Moore (ORCID: https://orcid.org/0000-0001-9103-7746)
- James Hargreaves (ORCID: https://orcid.org/0000-0002-3509-3572)
Institutions
- Centre for Infectious Disease Research in Zambia (ZM)
- Johns Hopkins University (US)
- Washington University in St. Louis (US)
- University of Alabama at Birmingham (US)
- London School of Hygiene & Tropical Medicine (GB)
- Faculty of Public Health (GB)
- University of California, Davis (US)
- University of Sheffield (GB)
Publication Details
- Journal
- PLoS Medicine
- Published
- 2025-09-03
- DOI
- https://doi.org/10.1371/journal.pmed.1004720
- Citations
- 1
- Primary Topic
- HIV/AIDS Research and Interventions
- Type
- article
- Field-Weighted Citation Impact
- 1.40
Funders
- Bill and Melinda Gates Foundation
- National Institutes of Health
- Centers for Disease Control and Prevention