Predictors of sustained human immunodeficiency virus viral-load suppression before and after the adoption of Treat All policy in Rwanda

Table 1 Comparison of characteristics between included study participants and those excluded from the analysis based on the documented number of viral load results, n (%)

Characteristics	n = 981	Number of viral load results
		One and excluded (n = 348)	≥ two and included (n = 634)	P value
Age (year), mean ± SD	39.2 ± 10.2	38.6 ± 9.6	39.5 ± 10.4	0.173
Age, year
18-24	24 (2.5)	7 (2.0)	17 (2.7)	0.702
25-34	328 (33.6)	121 (34.8)	208 (32.8)	-
35-44	411 (42.1)	152 (43.7)	263 (41.5)	-
45-54	132 (13.5)	42 (12.1)	90 (14.2)	-
≥ 55	82 (8.4)	26 (7.5)	56 (8.8)	-
Gender
Female	649 (66.1)	241 (69.5)	408 (64.5)	0.114
Male	331 (33.7)	106 (30.5)	225 (35.5)	-
Missing	2 (0.2)	1	1	-
Education
No education	432 (44.0)	162 (47.8)	270 (43.8)	0.240
≥ primary	523 (53.3)	177 (52.2)	346 (56.2)	-
Missing	27 (2.7)	9	18	-
HIV status disclosed
No	387 (39.4)	122 (35.2)	265 (42.0)	0.036a
Yes	588 (60.2)	225 (64.8)	591 (58.0)	-
Missing	4 (0.4)	1	3	-
Adherence
< 90%	250 (25.5)	105 (34.8)	145 (25.5)	0.004a
≥ 90%	621 (63.2)	197 (65.2)	424 (74.5)	-
Missing	111 (11.3)	46	65	-
Advance HIV disease
< 200	161 (16.4)	60 (17.2)	101 (15.9)	0.274
≥ 200	660 (67.2)	216 (62.1)	444 (70.0)	-
Missing	161 (16.4)	72 (20.7)	89 (14.0)	-
Timing of ART initiation
Before treat all	514 (52.3)	217 (62.4)	297 (47.2)	< 0.001a
After treat all	463 (47.2)	131 (37.6)	332 (52.8)	-
Missing	5 (0.5)	0	5	-

^aP < 0.05, indicates statistically significant results.

HIV: Human immunodeficiency virus; ART: Antiretroviral therapy.

Table 2 Incidence of sustained viral load suppression, persistent viremia, viral rebound, and new suppression among people living with human immunodeficiency virus in Rwanda

Characteristics	Sustained VLS		Persistent viremia		Viral rebound		Newly suppressed
	n/N	%	n/N	%	n/N	%	n/N	%
Overall	829/973	85.2	42/973	4.3	45/973	4.6	57/973	5.9
Age, year
18-24	21/27	77.8	1/27	3.7	4/27	14.8	1/27	3.7
25-34	271/314	86.3	10/314	3.2	15/314	4.8	18/314	5.7
35-44	332/405	82.2	22/332	5.4	21/405	5.2	30/405	7.4
45-54	130/137	94.9	3/137	2.2	3/137	2.2	1/137	0.7
≥ 55	75/90	83.3	6/90	6.7	2/90	2.2	7/90	7.8
Gender
Female	539/622	86.7	21/622	3.4	26/622	4.2	36/622	5.8
Male	288/349	82.5	21/349	6.0	19/349	5.4	21/349	6.0
Education
No education	341/423	80.6	27/423	6.4	24/423	5.7	31/423	7.3
≥ Primary	465/523	88.9	14/523	2.7	19/523	3.6	25/523	4.8
HIV status disclosed
No	348/406	85.7	13/406	3.2	19/406	4.7	26/406	6.4
Yes	475/561	84.7	29/561	5.2	26/561	4.6	31/561	5.5
Adherence
< 90%	175/217	80.6	17/217	7.8	14/217	6.5	11/217	5.1
≥ 90%	562/648	86.7	20/648	3.1	26/648	4.0	40/648	6.2
Advance HIV disease
Yes	122/157	77.7	14/157	8.9	12/157	7.6	9/157	5.7
No	585/671	87.2	18/671	2.7	28/671	4.2	40/671	6.0
Timing of ART initiation
Before treat all	389/451	86.3	24/451	5.3	17/451	3.8	21/451	4.7
After treat all	433/513	84.4	18/513	3.5	27/513	5.3	35/513	6.8

HIV: Human immunodeficiency virus; VLS: Viral load suppression; ART: Antiretroviral therapy.

Table 3 Predictors of sustained viral load suppression among people living with human immunodeficiency virus in Rwanda

Characteristics	Complete case analysis				Imputed datasets
	Bivariate		Multivariable		Bivariate		Multivariable
	IRR (95%CI)	P value	aIRR (95%CI)	P value	IRR (95%CI)	P value	aIRR (95%CI)	P value
Age, year
18-24	Reference	-	Reference	-	Reference	-	Reference	-
25-34	1.10 (0.86-1.40)	0.455	0.99 (0.83-1.19)	0.944	1.10 (0.86-1.40)	0.455	1.09 (0.87-1.35)	0.484
35-44	1.03 (0.81-1.32)	0.792	0.94 (0.78-1.14)	0.540	1.03 (0.81-1.32)	0.792	1.03 (0.83-1.29)	0.776
45-54	1.20 (0.94-1.52)	0.148	1.12 (0.92-1.35)	0.251	1.20 (0.94-1.52)	0.148	1.22 (0.97-1.52)	0.086
≥ 55	1.05 (0.81-1.37)	0.691	0.98 (0.80-1.22)	0.879	1.05 (0.81-1.37)	0.691	1.09 (0.85-1.36)	0.492
Gender
Female	Reference	-	Reference	-	Reference	-	Reference	-
Male	0.95 (0.89-1.02)	0.139	0.96 (0.89-1.03)	0.230	0.95 (0.89-1.02)	0.139	0.95 (0.89-1.02)	0.136
Education
No education	Reference	-	Reference	-	Reference	-	Reference	-
≥ Primary	1.08 (1.01-1.16)	0.012a	1.09 (1.01-1.17)	0.031a	1.09 (1.02-1.16)	0.012a	1.09 (1.02-1.16)	0.012a
HIV status disclosed
No	Reference	-	Reference	-	Reference	-	Reference	-
Yes	0.99 (0.93-1.05)	0.733	1.00 (0.94-1.09)	0.840	0.99 (0.93-1.05)	0.771	1.00 (0.94-1.06)	0.952
Adherence
< 90%	Reference	-	Reference	-	Reference	-	Reference	-
≥ 90%	1.09 (1.00-1.20)	0.050a	1.05 (0.96-1.15)	0.309	1.06 (0.99-1.15)	0.111	1.04 (0.96-1.12)	0.349
Advance HIV disease
No	Reference	-	Reference	-	Reference	-	Reference	-
Yes	0.87 (0.78-0.97)	0.014a	0.88 (0.79-0.99)	0.034a	0.89 (0.81-0.98)	0.020a	0.89 (0.82-0.98)	0.019a
Timing of ART initiation
Before treat all	Reference	-	Reference	-	Reference	-	Reference	-
After treat all	0.98 (0.92-1.04)	0.543	0.97 (0.90-1.05)	0.466	0.97 (0.92-1.04)	0.432	0.97 (0.91-1.04)	0.385

^aP < 0.05, indicates statistically significant results.

HIV: Human immunodeficiency virus; ART: Antiretroviral therapy; IRR: Incidence risk ratio; aIRR: Adjusted incidence risk ratio; CI: Confidence interval.

Table 4 Gradual viral load outcomes among 339 people living with human immunodeficiency virus who had three viral load results available

Number of people (%)	6 months	18 months	30 months
275 (81.2)	Suppressed	Suppressed	Suppressed
8 (2.4)	Suppressed	Suppressed	Unsuppressed
4 (1.2)	Suppressed	Unsuppressed	Suppressed
15 (4.4)	Suppressed	Unsuppressed	Suppressed
24 (7.1)	Unsuppressed	Suppressed	Suppressed
3 (0.9)	Unsuppressed	Unsuppressed	Suppressed
2 (0.6)	Unsuppressed	Suppressed	Unsuppressed
8 (2.4)	Unsuppressed	Unsuppressed	Unsuppressed