Drivers of virological non-suppression among adolescents and adults on antiretroviral therapy for HIV in Samburu East and Samburu Central Sub-Counties In Samburu County, Kenya

Abstract

Background: At the conclusion of 2019, Kenya achieved a 24% viral load (VL) non- suppression rate. However, based on the National AIDS and STI Control Program report in August 2018, Samburu County had a 33.2% VL non-suppression rate and was ranked as a poor-performing county in reference to the third “95” (viral suppression) strategy. However, Samburu East and Samburu Central sub-counties of Samburu County had poor VL non-suppression rates leading to high numbers of virological failures, an increase in the risk of HIV transmission, and early deaths. Objectives: To determine the proportion of adolescents and adults with non- suppressed viral load 6 months’ post ART initiation, describe socio-demographic characteristics, and determine factors associated with HIV viral load non-suppression among the adolescents and adults enrolled on ART in Samburu East and Samburu Central Sub-counties. Methods: This was a cross-sectional study involving a review of client ART records and face-to-face interviews using a structured questionnaire amongst the adolescents and adults enrolled in ART in six health facilities offering ART services in Samburu East and Samburu Central sub-counties. Viral load non-suppression was defined as having >1000 copies of viral RNA/ml of plasma after 6 months of treatment. A total of 276 participants from eligible individuals were selected randomly using Excel- generated random numbers. Calculation of relevant statistics for continuous and categorical data was done. A bivariate logistic regression model was used to analyze data to determine predictors of virological non-suppression, and factors showing a p<0.2 were added to a multivariate forward logistic elimination model. Results: The overall VL non-suppression in the two sub-counties was 26.3%. One hundred and sixty-nine 169 (67.3%) of the participants were females. The study participants' average age was 37.9 years (SD = 12.7). The average CD4 count of the study participants at baseline was 317 cells/mm3 (SD = 378.0 cells/mm3). For the WHO clinical stage, 103 (40.8%) were in stage I, 69 (27.6%) were in stage II, 70 (28.0%) were in stage III, and 9 (3.6%) were in stage IV. The independent variables that were associated with VL non-suppression include WHO clinical stage III and IV, which had higher odds of VL non-suppression (aOR = 12.20, 95% CI = 4.50 - 33.03, and poor adherence rating was also statistically associated with VL non-suppression (aOR = 5.91, 95% CI = (2.97-13.58). Regularly attending support group meetings had a protective effect against the VL non-suppression (aOR = 0.26, 95% CI = 0.10 - 0.71) on adolescents and adults on ART in Samburu East and Samburu Central sub- counties. Conclusion: The study identified a 26.3% rate of viral load non-suppression, underscoring a significant public health concern. Major factors included late care enrollment and poor adherence. Targeted interventions that are sensitive to gender and age, early diagnosis, ongoing treatment support, and regular involvement in support groups are crucial to enhance ART adherence and achieve viral suppression. Recommendation: The Samburu County Health Department should adopt a comprehensive strategy to reduce viral load non-suppression. Key actions include scaling up community sensitization, reinforcing ART adherence through guideline- based tools, and strengthening peer support groups to reduce stigma and improve motivation. These coordinated interventions aim to enhance treatment outcomes and achieve sustained viral suppression across the county.