article · BMC Infectious Diseases
This retrospective cohort study examined virological outcomes and determinants among 132 individuals living with HIV who were excluded from the NAMSAL clinical trial across three hospitals in Yaounde, Cameroon, between 2018 and 2021. For participants who remained retained in care, viral suppression rates were 77.3 percent at 48 weeks, 72.6 percent at 96 weeks, and 61.5 percent at 144 weeks after starting antiretroviral therapy. However, 56.1 percent of participants were lost to follow-up and 4.5 percent died during the monitoring period. Reduced chances of achieving viral suppression were significantly associated with baseline viral loads of 100,000 copies per millilitre or higher, unemployment, and receiving non-first-line antiretroviral regimens. The findings indicate that long-term patient retention poses a more substantial obstacle to success than virological efficacy alone.
Clinical trials frequently omit complex or high-risk patients, leaving real-world clinical outcomes for excluded populations unclear. By documenting substantial attrition alongside social and medical risk factors, this study highlights gaps in routine care delivery. The evidence helps healthcare planners recognise that sustaining long-term viral suppression requires targeted interventions to keep vulnerable, trial-ineligible individuals engaged in care.
The abstract does not indicate a direct commercial application pathway. The findings instead provide real-world observational data that healthcare providers, health software developers, and public health programmes could use to inform patient-retention strategies or adherence-monitoring tools. Any practical application of these insights remains at an early, conceptual stage.
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The NAMSAL (New Antiretroviral and Monitoring Strategies in Adults living with HIV in Low-income countries) trial was conducted in Yaoundé, Cameroon, to evaluate optimized antiretroviral treatment strategies. However, little is known about virological outcomes among individuals excluded from such trials. This study assessed viral suppression and associated factors among participants excluded from the NAMSAL trial. We conducted a retrospective cohort study in the three hospitals in Yaoundé (Yaoundé Central Hospital, Yaoundé Military Hospital and Cité Verte District Hospital) where the NAMSAL trial was implemented. Data collected between 2018 and 2021 were analyzed. Viral Suppression was defined as viral load < 1000 copies/mL. Among 204 excluded individuals identified, 132 participants with available virological data were included in the final analysis. Associated factors were analyzed in R using bivariate and multivariable logistic regression, with p < 0.05 considered statistically significant. Among 132 participants included in the analysis, the median age was 34 years (IQR: 30–44), and 51.5% of participants were male. During follow-up, 56.1% were lost to follow-up and 4.5% died. Among participants retained in care, viral suppression rates were 77.3%, 72.6%, and 61.5% at 48, 96, and 144 weeks after ART initiation, respectively. Higher baseline viral load ≥ 100,000 copies/mL (aOR 0.12 [95% CI 0.02–0.76], p = 0.025), unemployment (aOR 0.112 [95% CI 0.022–0.559], p = 0.008), and use of non–first-line ART regimens (aOR 0.09 [95% CI 0.02–0.48], p = 0.005) were associated with lower odds of favorable virological outcomes. Participants excluded from the NAMSAL trial who were retained in care achieved relatively high levels of viral suppression during early follow-up. However, substantial loss to follow-up may have led to overestimation of overall cohort outcomes. Strengthened retention and monitoring strategies represent the main challenge, more than virological efficacy, to improve long-term HIV care outcomes in people excluded from clinical trials. Not applicable.
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DOI: 10.1186/s12879-026-14259-6
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