Effect of the COVID-19 Pandemic on HIV-1 Viral Load Monitoring among Patients on ART at INSP, Guinea, 2014-2024

Therapeutic monitoring of people living with HIV (PLHIV) relies mainly on HIV viral load (VL) measurement. This study evaluated the impact of the COVID-19 pandemic on HIV-1 viral load testing among PLHIV on antiretroviral therapy (ART) at the National Institute of Public Health (INSP) in Guinea from 2014 to 2024. Methods: A retrospective cross-sectional study was conducted at the HIV/Hepatitis Molecular Biology Laboratory of INSP on 29,529 samples from PLHIV. Viral load was measured by real-time PCR using NorDiag/HAIN and Abbott platforms. Data were analyzed with R software. Virological failure was defined as a VL ≥ 1000 copies/mL. Results: A marked improvement in virological control was observed over time, increasing from 77.5% before the COVID-19 pandemic to 88.8% after, with a decrease in failure rates from 22.5% to 11.2%. Most samples were from women (72.8%) and adults aged 18-49 years. The average treatment duration increased from 3.9 to 6.3 years between the two periods. Health centers became the main referring structures post-pandemic, reflecting increased decentralization. Multivariate analyses showed that men, individuals under 18 years, and patients followed in university hospitals before the pandemic had a higher risk of virological failure. Conversely, patients followed in NGOs or health centers during the pandemic had better outcomes. Adult age, longer treatment duration, and first-line follow-up were associated with better viral suppression. Conclusion: The results reveal improved virological monitoring in Guinea despite disruptions caused by the pandemic. However, persistent inequalities call for targeted interventions to improve equity and achieve UNAIDS viral suppression targets.