Abstract
Introduction
HIV viral load testing (VLT) is a critical component of monitoring the effectiveness of antiretroviral therapy (ART) and evaluating progress toward the third “95” target of the UNAIDS 95-95-95 goals. Despite significant progress in scaling up VLT services in Cambodia, limited evidence exists regarding the coverage and determinants of VLT among individuals newly initiated on ART. This study aimed to assess the coverage of HIV viral load testing and identify factors associated with VLT uptake among people living with HIV (PLHIV) who initiated ART between January 2022 and June 2024 in Cambodia.
Methods
We performed a cross-sectional study using existing data from the National Center for HIV/AIDS, Dermatology, and STDs (NCHADS) between 1st January 2022 and 30th June 2024, with a total of 12,861 PLHIVs recorded. Descriptive statistics were used to summarize the characteristics of the patients and the proportions of PLHIV who underwent VLT and achieved a viral load suppression (VLS). Multivariable logistic regression with manual backward stepwise elimination was used to identify factors independently associated with VLT uptake after adjusting for potential confounders.
Results
The median age of the PLHIV was 32 years (IQR: 25-39), with 76.8% male patients. Among the 12,861 patients on ART, 10,356 (80.5%) had been on treatment for ≥ 6 months, and 7,615 patients (73.5%) had received at least one VLT. Among those tested, 91.4% achieved VLS, defined as a viral load < 1,000 copies/ml. Pediatric patients (<15 years) had slightly lower VLT coverage (72.4%) and substantially lower viral suppression rates (74.0%) than did adults (91.7%). In the multivariable logistic analysis, factors independently associated with higher VLT uptake included residing in coastal/seaside regions (AOR=1.46), working in informal or formal employment sectors (AOR=2.15 and 1.79, respectively), having higher educational attainment (AOR=1.57), having an ART duration of ≥6 months (AOR=28.69), and having higher CD4 counts. Conversely, residence in mountain and plateau regions was associated with lower VLT uptake (AOR=0.50).
Conclusion
While Cambodia has achieved commendable viral suppression rates, notable gaps remain in VLT coverage, particularly among pediatric populations and those living in remote regions, particularly mountain and plateau areas. Strengthening pediatric-specific strategies, expanding access in underserved areas, and addressing disparities in education and employment may help improve VLT uptake and overall HIV program outcomes.