Journal Article

Factors Associated with Viral Suppression Among Adolescents on Antiretroviral Therapy in Homa Bay County, Kenya: A Retrospective Cross-Sectional Study

Mwangi, Anne, van Wyk, Brian

2021

Overview

Despite the success in initiating adolescents living with HIV on antiretroviral therapy (ART), questions remain about factors affecting viral suppression. In Kenya, only 63% of adolescents (aged 10-19 years) on ART had achieved viral suppression in 2016. We investigated factors associated with viral suppression among adolescents initiated on ART before November 30, 2017 in Homa Bay County, Kenya. A retrospective cross-sectional analysis of 908 adolescents registered on ART for at least 6 months and with at least one documented viral load in the last 12 months, in six health facilities in Homa Bay County was conducted. Data were extracted from the electronic medical records and exported into an excel spreadsheet. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with viral suppression and adjust for confounding, using Stata 12.0. Out of all participants, 80% (726) had achieved viral suppression (<1,000 copies of viral RNA/mL of blood at latest viral load count). After adjusting for other covariates, adolescents with good adherence to ART (AOR=2.3, 95% CI=1.38-3.84) and a most recent CD4 count of above 500 cells/mm (AOR=1.87, 95% CI=1.13-3.08), were more likely to be virally suppressed. Adolescents on second line ART treatment (AOR=0.45, 95% CI=0.28-0.73) and having inadequate adherence to ART (AOR=0.26, 95% CI=0.11-63) were less likely to be virally suppressed. Viral suppression for adolescents on ART in this study is significantly higher than the national prevalence in 2016 (80% vs 63%), but it is still below the WHO target of 90%. Enhanced adherence support for adolescents on ART should be implemented to improve long-term adherence. Specific interventions are needed to \"rescue\" adolescents on second-line ART regimens who may have a history of poor adherence.

• Publisher: Dove Medical Press Limited,Taylor & Francis Ltd,Dove Press,Dove,Dove Medical Press
• Subject: Acquired immune deficiency syndrome / adherence / Adolescents / Age / AIDS / Analysis / Antiretroviral drugs / Antiretroviral therapy / Antiviral agents / CD4 antigen / Computer software industry / Confidence intervals / Cross-sectional studies / Drug resistance / Drug therapy / Electronic medical records / Ethics / Highly active antiretroviral therapy / HIV / Human immunodeficiency virus / International economic relations / Kenya / Medical records / Original Research / Patients / Teenagers / Variables / viral suppression / Youth