Clinical and demographic characteristics of adult patients experiencing virologic failure on antiretroviral therapy in the Blouberg sub-district, South Africa

Despite widespread access to antiretroviral therapy (ART) in South Africa, achieving and sustaining viral suppression remains challenging, particularly in resource-limited districts. Virologic failure compromises treatment outcomes, increases the risk of HIV drug resistance, and undermines national efforts to achieve the UNAIDS 95-95-95 targets. Understanding the clinical and demographic characteristics of patients experiencing virologic failure is important for strengthening HIV treatment programmes and patient management. To describe the clinical and demographic characteristics of adults experiencing virologic failure while receiving ART in the Blouberg sub-district of Capricorn District, Limpopo Province. A quantitative descriptive cross-sectional study was conducted through a retrospective review of 251 adult patient records across four high-volume primary healthcare facilities with viral suppression rates below 85%. Records of adults aged 18 years and older who had been on ART for at least 24 months and had a documented viral load greater than 1000 copies/mL after at least 24 months on ART were included based on predefined eligibility criteria. Data were extracted using a structured tool and analysed using SPSS version 28. Descriptive statistics were used to summarise demographic and clinical characteristics. Among patients included in the study, 73.3% were female. The majority (81.1%) initiated ART with CD4 counts below 350 cells/mm³, while 71.2% were classified as WHO clinical stage 1 or 2 at initiation. Most patients-initiated treatment on efavirenz-based regimen 1a. Elevated 12-month viral load levels (≥ 1000 copies/mL) were observed among 44.2% of patients. Patients experiencing virologic failure were predominantly female, initiated ART with low CD4 counts, and commonly received efavirenz-based regimens. The findings highlight the importance of early HIV diagnosis, strengthened adherence support, timely viral load monitoring, and optimization of ART regimens to improve treatment outcomes in rural settings. Targeted adherence interventions and earlier ART initiation strategies are needed to improve viral suppression outcomes in rural settings.