Factors associated with Viral Non-Suppression among HIV positive Adolescents in Chulaimbo Hospital, Kisumu County, Kenya, 2018

Abstract

Background: Kisumu County’s HIV prevalence of 19.9% is about three times higher than the national average. In 2015, 52% of new HIV infections reported in the County were among adolescents. Globally, HIV viral suppression rates among adolescents are low. Kenya has adopted the 90-90-90 targets by joint United AIDS (UNAIDS), one of which is to have 90% of all people receiving anti-retroviral therapy (ART) virally suppressed by 2020. Objectives: The objective of study was to estimate prevalence of viral non-suppression (VNS) and identify factors associated with VNS among HIV positive adolescents on ART at Chulaimbo Sub-County Hospital. Methods: This was a cross-sectional study among HIV positive adolescents (10-19 years) on ART for >6 months. They must have had a routine viral load (VL) test done in ≤ 6 months with valid laboratory results. Study sample was randomly selected from laboratory VL register. A VL of ≥1000 RNA copies/ml was considered non-suppressed. Using a pre-tested structured questionnaire, disclosure status and socio-demographic data were obtained; adherence to ART was measured by pill counts and abstraction for clinical data was done from medical records. Data analysis was done using Epi info version 7 and STATA software. To identify factors associated with VNS, we conducted bivariate analysis for crude odds ratio (cOR) and stratified logistic regression to control for confounding and check for effect modification by computing adjusted OR (AOR). Results: Out of 398 adolescents on ART, 212 had been tested for routine VL ≤ 6 months with valid VL results. Two hundred adolescents were randomly selected and interviewed; 103 (51.5%) were female; younger adolescents (10-14 years old) were 102 (51%) and 98 (49%) adolescents were 15-19 years old. The median duration on ART was 7.6 years (range 0.8-12.4years). One hundred and forty-two (71%) adolescents were on first line regimen and 58 (29%) on second line regimen; 110 (55%) had good (≥ 95%) adherence to ART. Seventy-one (35.5%) adolescents had VL result of ≥1000 RNA copies/ml. The odds of VNS were higher among those who had poor adherence to ART and there was effect modification with increasing age; older adolescents (AOR 13.93, 95% CI 3.20-60.74) compared to younger adolescents (AOR 4.41, 95% CI 1.18- 16.54), and in males (AOR 22.33, 95% CI 4.35-114.63) compared to females (AOR 3.92, 95% CI 1.09-14.04). Being on first line regimen was negatively associated with VNS for males (AOR 0.06, 95% CI 0.00-0.87) and older adolescents (AOR 0.02, 95% CI 0.00-0.20). Conclusion: The proportion of VNS was more than three times higher than the acceptable based on the 90% viral suppression target. Adolescents on second line regimens and those who are non- adherent to ART have higher odds of VNS, the odds being higher in males and older adolescents. Recommendations: County ART program should reinforce targeted interventions to motivate adherence in HIV infected males and older adolescents towards attaining the 90% target and improve the treatment outcomes.