Trends and factors associated with initiation of HIV treatment and uptake of viral load testing among PLHIV in Jamaica

IntroductionJamaica did not achieve the UNAIDS 90-90-90 targets in 2020. This study aims to examine trends and factors associated with uptake of HIV treatment and viral load testing among people living with HIV (PLHIV) in Jamaica, to make recommendations for improving patient management and outcomes. MethodsThis secondary analysis uses patient-level data from the National Treatment Service Information System. The baseline sample is PLHIV initiating anti-retroviral treatment (ART) between January 2015-December 2019. Descriptive statistics are used to summarize demographic and clinical variables. Multivariable logistic regression is used to assess factors associated with ART initiation (31+ days vs. same day) and viral load testing uptake (viral load test vs. no test), using categorical variables for age group, gender and regional health authority. Adjusted odds ratios and 95% confidence intervals are reported. ResultsSame day ART initiation increased by 72% over 5 years. The coverage of 1st viral load test was 90% but declined to 79% for the 2nd test. Testing occurred mostly after 0-6 months on ART (n=3047, 55%) and uptake was highest in the South-East Region (n=2885, 53%). Those virally suppressed were significantly more likely to have same day ART initiation compared to those non-suppressed (aOR=1.58, CI=1.43-1.75). Males were significantly more likely to have same day ART initiation (aOR=1.46, CI=1.32-1.62) but no first viral load test (aOR=1.55, CI=1.27-1.90) compared to females. ConclusionThe goal of immediate ART initiation is increasingly being met and is significantly associated with viral suppression at the first viral load test. Males were less likely to have a viral load test after ART initiation. A qualitative assessment should be conducted to understand important challenges faced to access routine viral load testing, followed by implementation of differentiated service care models, targeting males.