article · International Journal of STD & AIDS
Enhanced Adherence Counselling was introduced by the World Health Organization to help people living with HIV on antiretroviral therapy achieve viral suppression. An evaluation of records from eight high-volume care and treatment clinics in Ilala, Dar es Salaam, assessed how well this intervention works in practice. Among 361 patients identified with high viral loads in 2023, 86.2 percent enrolled in counselling and 70.9 percent completed the sessions. The median time to start counselling was 27 days, and most participants finished within three months. Of those who completed the full counselling programme, 68.4 percent successfully suppressed their viral load. Likelihood of suppression was linked to age and starting viral load: younger patients were less likely to suppress the virus, whereas those with lower initial viral loads had better outcomes. Gaps in enrolment and completion continue to limit the overall impact of the programme.
Antiretroviral therapy relies on strict adherence to keep HIV suppressed and prevent transmission. While structured counselling programmes help over two-thirds of completing patients lower their viral loads, delays in starting and high drop-out rates reduce their overall benefit. Understanding who struggles most, such as younger patients, helps clinics refine adherence support to ensure more people successfully control the infection.
The findings provide operational evidence for public health authorities, clinic administrators, and non-governmental organisations delivering HIV care programmes. Rather than offering a commercial product, the applied findings highlight a tested clinical workflow where service delivery improvements, patient tracking, and targeted support for younger demographics are required to improve counselling completion and treatment outcomes in real-world clinic settings.
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BackgroundDespite Antiretroviral Therapy (ART) progress, Human Immunodeficiency Virus (HIV) remains a major issue in Tanzania (4.65% prevalence). World Health Organization (WHO) introduced Enhanced Adherence Counselling (EAC) in 2016 to improve adherence, but many patients still struggle to suppress viral load after EAC.ObjectiveThis study evaluated the effectiveness of Enhanced Adherence Counselling for people living with HIV with unsuppressed viral load in Ilala, Dar es Salaam.MethodsA cross-sectional study was conducted in eight Ilala Care and Treatment Clinic (CTCs), selected using multistage sampling based on patient volume, for this study, patient volume was defined as the number of CTC clients, with high-volume facilities referring to those serving more than 1000 patients. Records of patients with unsuppressed viral load (≥1000 copies/mL) in 2023 were reviewed. Data were analysed in STATA SE 14 using descriptive, ordered, and multivariable logistic regression, with significance set at p < 0.05.ResultsOut of 361 people living with HIV with high viral load, 86.2% enrolled in EAC and 70.9% completed it. Among completers, 68.4% achieved viral suppression. Viral load suppression was significantly associated with age and initial viral load, with younger individuals being less likely to achieve suppression, while those with lower initial viral load (VL) had a higher likelihood of suppression. Median EAC initiation time was 27 days, with most completing it within 3 months.ConclusionThe study reveals gaps in transitioning people living with HIV with unsuppressed viral load to EAC enrolment and completion, undermining EAC's effectiveness. While 68% viral load suppression among those who completed EAC is promising, low enrolment and retention into EAC may impact overall success. Further research is needed to explore barriers to full participation into EAC sessions and its impact on viral load suppression.
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DOI: 10.1177/09564624251392811
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