Unsuppressed viral load and its associated factors among people living with HIV on antiretroviral therapy: a cross-sectional study

Abstract Objective This study aimed to assess the prevalence of unsuppressed viral load and its associated factors among people living with HIV (PLWH) receiving antiretroviral therapy (ART) in the Xinjiang Production and Construction Corps (XPCC). Methods Clinical data and questionnaires were collected from four divisions of the XPCC via random sampling. Logistic regression and mediation analyses were performed to identify factors associated with unsuppressed viral load. Results Among 369 PLWH, 55 (14.91%) had unsuppressed viral load. Associated factors included CD4+ T-cell count ≥ 500 cells/μL, treatment duration ≥ 3 years, alcohol consumption, discrimination, poor ART adherence, and poor self-efficacy (all p < 0.05). ART adherence played a full mediating role between self-efficacy, social support and unsuppressed viral load in PLWH, with a mediation effect value (a*b) of β = −0.010 (95% CI: −0.013, −0.006) and β = −0.021 (95% CI: −0.029, −0.014). Greater social support and higher self-efficacy reduce the risk of unsuppressed viral load in PLWH via improved ART adherence. Additionally, the “social support ⇒ medication adherence” pathway exerted a partial chain mediating role between self-efficacy and viral load suppression in PLWH, with a mediation effect value (a*b) of β = −0.012 (95% CI :-0.017, −0.006).Social support can first enhance patients’ self-efficacy, which in turn further improves ART adherence, thereby reducing the risk of unsuppressed viral load. Conclusions In the XPCC, the viral suppression rate among PLWH has not yet met the UNAIDS 95–95-95 target. Priority should be given to PLWH with <3 years of treatment and CD4+ T-cell count < 500 cells/μL. HIV-related education should be delivered to individuals, families and the public to enhance social support and self-efficacy, reduce HIV-related stigma, and promote healthy lifestyles (e.g. reduced alcohol consumption). These measures will improve adherence to ART, thereby achieving effective viral load suppression.