Title : Predictors of durable viral suppression among people living with HIV (PLHIV) on antiretroviral treatment in Almaty, Kazakhstan
Abstract:
Background: The Republic of Kazakhstan is intensifying efforts to achieve the UNAIDS 95-95-95 targets as part of its national strategy to end the HIV/AIDS epidemic by 2030. According to national data, the HIV care continuum cascade among people living with HIV (PLHIV) in 2024 showed that 83% of PLHIV knew their HIV status, 90% were receiving antiretroviral therapy (ART), and 92% of those on ART had achieved an undetectable viral load. Achieving and maintaining viral suppression is essential both for reducing HIV transmission and preserving long-term health among PLHIV. This study aimed to assess the level of durable viral suppression and identify its predictive factors among PLHIV attending the AIDS Center in the City of Almaty.
Method:. We analyzed dispensary records of PLHIV receiving treatment at the AIDS Center in Almaty. The primary outcome variable was durable viral suppression, defined as being on ART for at least one year and having two consecutive undetectable viral load measurements (≤50 copies/mL). Independent variables included age, sex, education, marital status, region of residence, route of HIV transmission, HIV stage at diagnosis, duration of ART, ART adherence assessed through periodic pill counts, initiation of ART before or after implementation of the national Test-and-Treat policy on May 30, 2017, and comorbidities including tuberculosis, hepatitis C, and alcohol misuse. We first fitted univariable logistic regression models for demographic characteristics and factors potentially associated with durable viral suppression, followed by a multivariable logistic regression model including all variables of interest.
Results: Among 2,540 PLHIV receiving ART at the Almaty AIDS Center, 76.1% achieved durable viral suppression. Multivariable analysis identified four factors significantly associated with durable viral suppression: marital status, route of HIV transmission, duration of ART, and adherence level. PLHIV with adherence levels ≥95% had substantially greater odds of durable viral suppression compared with those with lower adherence (aOR 13.3, 95% CI: 9.45–18.58). Individuals who acquired HIV through injection drug use had lower odds of durable viral suppression compared with those infected through heterosexual transmission (aOR 0.73, 95% CI: 0.58–0.93). Similarly, cohabitating individuals (aOR 0.66, 95% CI: 0.48–0.92) and patients who had been on ART for 1–5 years (aOR 0.65, 95% CI: 0.52–0.81) had lower odds of durable viral suppression compared with married individuals and those receiving ART for more than five years, respectively.
Conclusion: Initiation of ART is essential; however, sustained adherence is critical to achieving its full benefits. Our findings identify population groups in Almaty who may require enhanced adherence support, particularly individuals with histories of substance use, and provide evidence to inform refinement of the national Test-and-Treat strategy. Future research should further examine the mechanisms through which these factors influence viral suppression and evaluate targeted interventions. Differentiated care models should also be considered for PLHIV who have achieved durable viral suppression.
