Examining and classifying reasons for missing viral loads among adults living with HIV

An extended outcome investigation and ascertainment approach in Western Kenya

Bibliographic Data

ID19592025
AuthorsHarriet Fridah Adhiambo (0000-0002-5323-5474, University of Washington), Jayne Lewis-Kulzer (0000-0003-3314-9891, University of California, San Francisco), Edwin Nyagesoa (Kenya Medical Research Institute), Steven Gimbel (0000-0003-3330-1208, University of Washington), Sarah Gimbel, Eliud Akama (0000-0003-1567-4756, University of Washington), Dorothy I Mangale (0000-0003-1264-405X, Washington University in St. Louis), Lina Montonya (University of North Carolina at Chapel Hill), Ingrid Eshun-Wilson (0000-0002-4049-9868, Washington University in St. Louis), Sarah Iguna (0000-0001-9019-6032, Kenya Medical Research Institute), Everlyne Nyandieka (Kenya Medical Research Institute), Elizabeth A Bukusi (0000-0002-2031-2808, Kenya Medical Research Institute), Elizabeth Bukusi, L Abuogi (0000-0003-1492-5090, University of Colorado Denver), Thomas Odeny (0000-0002-1644-2378, Washington University in St. Louis), Maya L Petersen (0000-0002-5505-153X, University of California, Berkeley), Elvin Geng (0000-0002-0825-1424, Washington University in St. Louis), Elvin H Geng
EditorsVishal Goyal Vishal Goyal
Year2025
Volume5
Issue5
Pagese0004038
Publication date2025-05-12
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0004038
PMID40354456
OpenAlexW4410294460
LanguageEN
Citations received1
References cited34

Gaps in HIV RNA monitoring persist globally impeding the ability to determine clinical progress and outcomes. This study systematically evaluated provider (e.g., guideline non-adherence), system (e.g., laboratory error) and participant-level (e.g., refusal) drivers of missed viral load (VL) monitoring measurements among people with HIV in Kenya. Adults aged 18–65 years were followed across five health facilities in Kenya as part of a clinical trial (NCT#02338739) where HIV RNA monitoring was done routinely. Instances of missed VL despite being indicated per Kenyan guidelines were identified. An algorithm for assessing root causes of missing HIV RNA was developed and generalized linear models estimated the risk ratios (RR) for participant-level characteristics associated with missed viral load. Among 1,754 participants (66% female), the prevalence of missed viral load in year one and two was 24.4% and 29.4%, respectively. Drivers for missed viral load measurements included loss to follow up (51.5% in year one and 57.8% in year two), clinician non-adherence with guidelines (36.7% in year one and 32.2% in year two), unknown (10.3% in year one and 8.6% in year two), and requested but not collected (1.5% in year one and 1.3% in year two). Participants aged

Biology · Environmental health · Family medicine · Guideline · Kenya · Pathology · Population · Socioeconomic status · Viral load · Demography · HIV Research and Treatment · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Pediatrics