Treatment outcomes 12 months after antiretroviral therapy initiation in Oman: a nationwide study from the Middle East.

ABSTRACTWe used routinely collected programme data on people living with HIV in Oman who started ART in 2014-2018 to assess retention on ART, viral suppression, attrition (mortality or loss to follow-up [LTFU]) and treatment failure (attrition or HIV viral load of > 1000 copies/mL) 12 months after antiretroviral therapy (ART) initiation. We identified 726 patients; 72% were male. Overall, 12 months retention on ART and viral suppression (intention-to-treat [ITT] analysis) were 85.7% and 74.5%, respectively. Attrition occurred in 14.3% (mortality of 7% and LTFU of 7.3%). Retention increased from 78.8% (93/118) to 90.6% (144/159) among patients who started ART in 2014 and 2018, respectively. Similarly, ITT and on-treatment analyses revealed that viral suppression 12 months after ART initiation increased from 57.6% (68/118) and 73.1% (68/93) among patients who initiated therapy in 2014-80.5% (128/159) and 88.8% (128/144) among patients started treatment in 2018, respectively. On multivariate analysis, older age, having "Other" as an HIV risk factor (compared to heterosexual) and receiving HIV care outside the capital Muscat independently predicted both attrition and treatment failure. Our findings have been useful in identifying factors at the individual and programme level that influenced the risk of attrition and treatment failure.

Disparities between HIV patient subgroups in Oman: An analysis of the 2019 cascade of care.

BACKGROUND: The HIV cascade of care is a framework for monitoring HIV care, identifying gaps and informing appropriate interventions. This study aimed to describe the cascade of care in Oman in 2019 and highlight disparities at the sub-population level. METHODS: We used the UNAIDS Spectrum modelling software to estimate the number of people living with HIV. A national HIV surveillance database was used to identify Omani people (≥13 years old) diagnosed with HIV from 1984 through December 2019. We calculated the cascade indicators as of 31 December 2019 stratified by sex, age, HIV risk factor, residence, and region of HIV care. We also performed multivariate logistic regression to determine the predictors of attrition at linkage, retention, on ART, and viral suppression. RESULTS: As of December 2019, the estimated number of people living with HIV in Oman was 2440. Out of the estimated number of people living with HIV, 69% were diagnosed, 66% were linked to care, 61% were retained in care, 60% were on ART, and 55% were virally suppressed. Of the 1673 diagnosed individuals, 96% were linked to care, 88% were retained in care, 87% were on ART, and 81% were virally suppressed. People who received HIV care outside Muscat had the largest attrition (11% loss) in the transition from linkage (97%) to retention (86%). Similarly, people aged 13-24 years had the largest attrition (13% loss) from "on ART" (88%) to viral suppression (75%). Logistic regression showed that both not reporting a specific HIV risk factor and receipt of HIV care outside Muscat independently predicted attrition at each cascade stage from linkage to care through viral suppression. CONCLUSIONS: Our findings identified substantial disparities across various subpopulations along the cascade of care in Oman. This analysis will be invaluable in informing future interventions targeting patient subgroups who are at the highest risk of attrition.