Clinic-level and Individual-level Factors That Influence HIV Viral Suppression in Adolescents and Young Adults: a National Survey in Kenya

Overview

Journal AIDS

Specialty Infectious Diseases

Date 2020 Apr 15

PMID 32287060

Citations 19

Authors

Irene Njuguna

Jillian Neary

Caren Mburu

Danae Black

Kristin Beima-Sofie

Anjuli D Wagner

Cyrus Mugo

Yolanda Evans

Brandon Guthrie

Janet Itindi

Alvin Onyango

Laura Oyiengo

Barbra A Richardson

Dalton Wamalwa

Grace John-Stewart

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine clinic-level and individual-level correlates of viral suppression among HIV-positive adolescents and young adult (AYA) aged 10-24 years receiving antiretroviral treatment (ART).

Design: Multilevel cross-sectional analysis using viral load data and facility surveys from HIV treatment programs throughout Kenya.

Methods: We abstracted medical records of AYA in HIV care, analyzed the subset on ART for more than 6 months between January 2016 and December 2017, and collected information on services at each clinic. Multilevel logistic regression models were used to determine correlates of viral suppression at most recent assessment.

Results: In 99 HIV clinics, among 10 096 AYA on ART more than 6 months, 2683 (27%) had unsuppressed viral load at last test. Among 16% of clinics, more than 80% of AYA were virally suppressed. Clinic-level correlates of individual viral suppression included designated adolescent spaces [aOR: 1.32, 95% CI (1.07-1.63)] and faster viral load turnaround time [aOR: 1.06 (95% CI 1.03-1.09)]. Adjusting for clinic-level factors, AYA aged 10-14 and 15-19 years had lower odds of viral suppression compared with AYA aged 20-24 years [aOR: 0.61 (0.54-0.69) and 0.59 (0.52-0.67], respectively. Compared with female patients, male patients had lower odds of viral suppression [aOR: 0.69 (0.62-0.77)]. Compared with ART duration of 6-12 months, ART for 2-5, above 5-10 or more than 10 years was associated with poor viral suppression (P < 0.001).

Conclusion: Dedicated adolescent space, rapid viral load turnaround time, and tailored approaches for male individuals and perinatally infected AYA may improve viral suppression. Routine summarization of viral load suppression in clinics could provide benchmarking to motivate innovations in clinic-AYA and individual-AYA care strategies.

Citing Articles

Prevalence and Determinants of Viral Suppression in Young People Living with HIV on Antiretroviral Therapy in Southern Africa: A Cross-Sectional Analysis of HIV Survey Data of 2020 and 2021.

Msosa T, Kabaghe A, Twabi H, Mpinganjira S, Mzumara W, Sumari-De Boer M AIDS Behav. 2025; .

PMID: 40029578 DOI: 10.1007/s10461-025-04662-6.

Using Machine Learning Techniques to Predict Viral Suppression Among People With HIV.

Yang X, Cai R, Ma Y, Zhang H, Sun X, Olatosi B J Acquir Immune Defic Syndr. 2024; 98(3):209-216.

PMID: 39561000 PMC: 11798697. DOI: 10.1097/QAI.0000000000003561.

Genetic landscape for majority and minority HIV-1 drug resistance mutations in antiretroviral therapy naive patients in Accra, Ghana.

Appiah P, Gbassana G, Adusei-Poku M, Obeng B, Duedu K, Sagoe K Heliyon. 2024; 10(12):e33180.

PMID: 39022058 PMC: 11253264. DOI: 10.1016/j.heliyon.2024.e33180.

An Integrated Sample Referral System for HIV Viral Load and Early Infant Diagnosis in North-Western Province, Zambia-A Retrospective Cross-Sectional Study.

Shempela D, Sikalima J, Mwandia J, Mwila E, Chilyabanyama R, Masona M Healthcare (Basel). 2024; 12(6).

PMID: 38540582 PMC: 10970232. DOI: 10.3390/healthcare12060618.

Temporal dynamics and drivers of durable HIV viral load suppression and persistent high- and low-level viraemia during Universal Test and Treat scale-up in Uganda: a population-based study.

Rosen J, Ssekubugu R, Chang L, Ssempijja V, Galiwango R, Ssekasanvu J J Int AIDS Soc. 2024; 27(2):e26200.

PMID: 38332519 PMC: 10853573. DOI: 10.1002/jia2.26200.

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