Women in British Columbia Have High Awareness of Viral Load

Adverse sociodemographic factors did not affect the ability of women with HIV living in British Columbia to estimate their latest viral load, according to a study published in HIV Medicine.¹ This result confirms that women living in British Columbia possessed awareness of their viral load status despite any sociodemographic experiences.

Women living in Canada taking antiretroviral therapy (ART) for HIV were less likely to have a suppressed viral load compared with men (81% vs 98%).² Health outcomes and mortality are affected by detectable viral load² and are valuable in research, where they are more often self-reported. However, the accuracy of self-reported viral load has been in question due to a lack of studies comparing self-report to clinically evaluated viral load. This study aimed to assess the validity of self-reporting viral load as well as whether social determinants of health are associated with matching clinically confirmed and self-reported viral load.

The British Columbia CARMA-CHIWOS Collaboration study was used for its data to supplement the study. All participants were aged 16 years and older and included those with and without HIV. This study used data from December 2020 to August 2023 from women living with HIV who completed a survey that included questions on their viral load. Participants were asked what their most recent viral load was, and their answer was compared with a chart review. A validation analysis was conducted in women who had both a self-reported viral load and a viral load based on the chart review. Time since diagnosis, age, health literacy, lifetime history of homelessness, ethnicity, substance use, and use of ART were also collected in the survey.

Woman were able to correctly report their viral load status when self-reporting | Image credit: Siam - stock.adobe.com

There were 219 women included in this study who were living with HIV in British Columbia. A total of 95% of the participants could estimate their recent viral load, of which 91% did so accurately. This equated to an 86% concordance rate across all participants. A total of 96% of the women who were able to estimate their viral load were also on ART, of which 87% had an undetectable viral load. A total of 73% of the women who could not estimate their viral load were on ART.

Self-reported undetectable viral load had a high concordance of 91% with clinical chart values. Predictive values, sensitivity, specificity, and likelihood ratios were similar across sociodemographic groups. Specificity was lowest in Black women and women who reported either past substance abuse or no substance abuse (33.3% in both), which meant that women who were undetectable in their chart reported that they were detectable in their self-reported survey. Negative predictive values were also found in those who never experienced homelessness (50%) and those who reported no current substance use (50%), which meant that half of these women reported being detectable even though their chart stated that they were undetectable.

There were some limitations to this study. The study included a small sample size, which could have affected the results. Undetectable viral load also had a strict definition of less than 40 copies/mL, which could lead to misclassification based on other definitions. Most of the women included were living in urban areas and had easy access to care.

The authors concluded that “women living with HIV in British Columbia are generally well aware of their HIV suppression status regardless of adverse sociostructural experiences, making self-reported HIV [viral load] a reliable HIV care outcome for studies relying on [self-reporting].” Further research on the discordant reporting of viral load through self-report and clinical charts is needed to confirm these findings.

References

1. Povshedna T, Swann SA, Silva MAP, et al. Self-reported HIV viral load is reliable and not affected by adverse lived experiences of women living with HIV in British Columbia. HIV Med. Published online May 6, 2025. doi:10.1111/hiv.70035
2. Hosein SR. British Columbia HIV study finds life expectancy differences based on sex assigned at birth. Catie. April 24, 2025. Accessed May 6, 2025. https://www.catie.ca/catie-news/british-columbia-hiv-study-finds-life-expectancy-differences-based-on-sex-assigned-at