Factors associated with HIV viral suppression among adolescents in Kabale district, South Western Uganda

Abstract

Background The goal of antiretroviral therapy is to achieve sustained human immune deficiency virus (HIV) viral suppression. However, research on factors associated with viral load suppression among adolescents in low and middle-income countries is limited. The objectives of this study were to determine HIV viral suppression levels among adolescents in Kabale district and the associated clinical, adherence and psychosocial factors. Methods Cross-sectional and retrospective cohort study designs were used. Two hundred and forty-nine adolescents living with HIV that attended clinics between September and October 2019 at nine health facilities were interviewed and their medical records reviewed. A data abstraction tool was used to collect clinical data from adolescent’s clinical charts, face to face interviews were conducted using semi-structured questionnaire adopted from the HEADS tool and in-depth interviews conducted with ten key informants. Qualitative data was analyzed using thematic content analysis. Logistic regression was used to determine the magnitude by which clinical and psychosocial factors influence viral load suppression. Odds Ratios (ORs) were used for statistical associations at 95% confidence interval considering statistical significance for p-values less than 0.05. Qualitative data collected from Key informants to support our quantitative findings was analyzed using thematic content analysis. Results HIV viral suppression among (n = 249) adolescents was at 81%. Having no severe opportunistic infections was associated with viral load suppression among adolescent living with HIV (OR = 1.09; 95%CI [1.753–4.589]; p<0.001) as well as having no treatment interruptions (OR = 0.86; 95% CI [2.414–6.790]; p = 0.004). Belonging to a support group (OR = 1.01; 95% CI [1.53–4.88]; P = 0.020), having parents alive (OR = 2.04; 95% CI[1.02–4.12]; P = 0.047) and having meals in a day (OR = 5.68; C.I = 2.38–6.12, P = 0.010), were significantly associated to viral load suppression. The findings also indicated that long distances from health facilities, transport challenges and unprofessional conduct of health workers that make adolescent unwelcome at health facilities negatively affected viral suppression among adolescents. Conclusion The findings indicate that HIV viral suppression among adolescents on ART was at 81%. Kabale district was likely not to achieve the third 90 of the UNAIDS 90-90-90 global target for this population category. The findings further indicate that having no severe opportunistic infection and no treatment interruptions, good nutrition status, peer support and support from significant others, were highly associated with viral load suppression.

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“…In this study, poor level of adherence and fair level of adherence showed a high proportion of non-viral suppression (14.8%; X 2 =18.55; P= <0.001), a significantly high proportion of non-viral suppression among poor adherence also reported from Amhara region, Ethiopia [25] and Kenya [30]. Exposure to opportunistic infection was one of the associated factors for HIV viral non-suppression in this study, which is in line with the results reported from Uganda [33] and Ethiopia [34], even though both studies were performed on all Adult HIV patients who were taking ART.…”

Poor adherence to antiretroviral therapy among adult people living with HIV initiated during the COVID-19 epidemic waves – observations at the University Teaching Hospital in Lusaka, Zambia

“…Treatment duration has been found to have a mixed effect on viral suppression. Studies conducted in Uganda and Kenya found no association between the two (25,26). Even though studies conducted in Ghana and Zimbabwe found that longer duration was associated with higher levels of viral suppression, the cutoff duration points were 3 years and 4.5 months, respectively (27,28).…”

Household transport ownership and HIV viral suppression in rural Uganda: a cross- sectional, population-based study

“…3 For example, one study in south-central Uganda reported a viral suppression rate of 72.4% at the end of 2022; 4 another study conducted in south-western Uganda among adolescents found 81% viral suppression. 5 This threatens to stall progress in the HIV response towards the UNAIDS 95-95-95 HIV treatment targets by 2030. 6 Multiple studies, including a systematic review of studies in sub-Saharan Africa, have highlighted absence of transport as a potential barrier to antiretroviral therapy adherence.…”

“…3 For example, one study in south-central Uganda reported a viral suppression rate of 72.4% at the end of 2022; 4 another study conducted in south-western Uganda among adolescents found 81% viral suppression. 5 This threatens to stall progress in the HIV response towards the UNAIDS 95-95-95 HIV treatment targets by 2030. 6…”