Background: World Health Organization has recommended enhanced adherence counseling (EAC) for HIV infected individuals with high viral loads before diagnosing first line treatment failure. This study aimed to evaluate outcomes of EAC among people living with HIV (PLHIV) with high viral load and its associated factors from a programme clinic in Pune, India. Methodology: A retrospective study among PLHIV accessing antiretroviral therapy (ART) was conducted between March 2020 and February 2022. PLHIV with initial high viral load (≥1000 copies/ml) followed by three EAC sessions and a repeat viral load were included in the study. Multivariate logistic regression was used to assess the factors associated with virological suppression. Results: Of the total 170 PLHIV, 81 (47.6%) showed virological suppression. The median duration to start 1st EAC session after initial high viral load was 1 month (IQR: 1-2). Being female (AOR 2.21; 95% CI: 1.13-4.31; p=0.021), literate (AOR 2.70; 95% CI: 1.12- 6.53; p=0.027), on second line ART regimen (AOR 2.58; 95% CI: 1.16-5.74; p=0.020) and EAC initiation within a month (AOR 2.25; 95% CI: 1.17-4.34; p=0.016) were significantly associated with virological suppression. Conclusions: Timely initiation of enhanced adherence counseling after high viral load is important. EAC should be strengthened among PLHIV with low literacy level and on first line ART. Effective pictorial tools during EAC sessions may be useful to get better understanding and subsequently improving ART adherence. Larger studies along with qualitative aspects will help in achieving ambitious target of 95% virological suppression among PLHIV in India.

PRAJAKTA KADALE