Women With 90% ART Adherence More Likely to Report Viral Suppression

Women living in Canada with HIV were found to have higher rates of viral suppression when reporting that adherence to their antiretroviral therapy (ART) totaled 90% adherence or higher, according to a new study published in HIV Medicine.¹

The Joint United Nations Programme on HIV/AIDS has previously set a global goal of reaching 95-95-95, representing the percentage of people who should know their HIV status, receive antiretroviral therapy, and be virally suppressed.² The Public Health Agency of Canada found that Canadian women were below these targets nationally, at 88-85-90. Nonadherence to ART could be sparked by multiple things, including stigma, economic insecurity, and depressive symptoms, especially in women. Viral suppression achieved through ART could be achieved with lower adherence than the standard of 95%, but the exact percentage of adherence required is not known. This study aimed to assess the viral suppression of women in Canada and establish the association between self-reported adherence and viral suppression based on how well the patient adhered.

The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study was used for its survey data in this study. Participants who were aged 16 years or older, had been diagnosed with HIV, and self-identified as a woman were included in the study. All participants completed surveys at baseline, 18 months, and 36 months in 3 waves that took place from October 2013 to May 2015, September 2015 to January 2017, and March 2017 to September 2018. History of HIV and ART, sociodemographic data, health and social services utilization, and emotional well-being were among the data collected in the survey. Participants who included their level of ART adherence and viral suppression at each study wave were included in a longitudinal analysis that described ART use across the waves.

Women living in Canada with HIV maintained viral suppression at 90% to 94% adherence to ART | Image credit: Krakenimages.com - stock.adobe.com

Adherence, viral load, and ART regimen were all self-reported and made up the main measures of the study. Adherence was reported between 0% and 100%, and viral load was reported as detectable or undetectable based on whether the participant had less than 50 copies/mL or 50 copies/mL or higher. All participants were also asked which ART they were taking at the time of the survey.

There were 1187 women included in this study, of whom 42.0% self-identified as White, 29.4% as Black, and 21.0% as Indigenous. The median (IQR) age was 42 (35.0-50.0) years. Most of the participants (85.8%) reported having at least a high school degree, and 90.1% had stable housing.

A total of 82.6% of the participants reported using ART. Viral suppression was reported in 89.6% of the participants who used ART as a backbone with a third-agent regimen compared with 83.5% virally suppressed in those who used other regimens. Undetectable viral load was reported in 31.5% of those who were not on ART. The participants in the group that did not receive ART were primarily Indigenous (33.8%), had been living with HIV for less than 6 years (48.3%), and had never accessed care for HIV (12.6%).

There was a 65.7% retention rate through all 3 waves, with 617 who were included due to their reporting of their adherence. A total of 95.5% of those who were included reported viral suppression, and 76.2% reported an adherence level of 95% or higher. A lower proportion of reported viral suppression was found in those who reported less than 65% adherence (76.5%; 95% CI, 50.1-93.2). Those who reported adherence levels of 95% or higher had higher reported viral suppression (97.0%; 95% CI, 95.1-98.36). This was similar to the percentage of participants who reported viral suppression when adherence was between 90% and 94% (97.2%; 95% CI, 90.3-99.7). The odds of reporting viral suppression were not statistically different when reporting 90% to 94% adherence (adjusted OR, 1.04; 95% CI, 0.20-5.32).

There were some limitations to this study. The small sample size may have affected the power to detect significant differences between the groups. Social desirability and recall bias are possible due to all participants' self-reported adherence and viral suppression. It is unknown if those with mental health conditions were receiving treatment for those conditions. Duration of viral suppression was also not collected. Selection bias is possible due to high attrition across the waves.

The researchers concluded that “a high level of adherence, at least 90%, is more likely to be associated with viral suppression among women living with HIV.” Research on the association between the type of regimen and adherence levels could prove to illuminate the connection between them.

References

1. Mokaddam M, Kronfli N, Sheehan NL, et al. Antiretroviral therapy use, self-reported adherence, and viral suppression among women living with HIV in Canada. HIV Med. Published online May 2, 2025. doi:10.1111/hiv.70034
2. New report from UNAIDS shows that AIDS can be ended by 2030 and outlines the path to get there. News release. UNAIDS; July 13, 2023. Accessed May 5, 2025. https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2023/july/unaids-global-aids-update