Prevalence and factors associated with viral suppression among HIV positive young adults receiving antiretroviral therapy in KCCA Clinics

Abstract

Introduction: Over 30% of all new HIV infections globally are estimated to occur among young adults aged 15 to 24 years. Despite improving access to antiretroviral therapy (ART), young adults have been reported to have low viral suppression rates. Studies assessing viral load suppression among HIV positive young adults receiving care in Uganda have been conducted in program settings. However, there are differences between ART care in program and public settings. Since it is difficult to generalize findings from previous studies, it is necessary to conduct similar studies in public facility settings. Objectives: This study aimed to determine the prevalence and factors associated with viral suppression among young adults receiving antiretroviral therapy in KCCA clinics. Methods: A cross sectional study was conducted using medical records of 729 systematically sampled young adults who were receiving ART from 1st January 2017 to 31st August 2018 in five KCCA clinics. Patients’ files were retrieved and data on viral load status at six months after ART initiation, age, sex, education level, disclosure status, adherence, smoking status, alcohol intake, baseline CD4 count, opportunistic infections, ART regimen, adverse drug reactions were collected by trained research assistants using pretested data abstraction forms. Data were analyzed with STATA version 13.0 using modified poisson regression with clustered robust standard errors. Results: Of the 729 young adults of whom majority were females, 94.4% (95% CI: 90.7 – 98.0) had achieved viral load suppression after six months of ART. Adherence ≥85% (aPR = 2.91, p = <0.001) and older age (aPR = 1.05, p = 0.008) were associated with improved viral suppression while experiencing opportunistic infections over the last six months (aPR = 0.83, p = <0.001 ) reduced the chances of viral supression. Conclusion: Viral suppression among young adults attending KCCA clinics is high above the UNAIDS target and it improves with older age and adherence to ART while experiencing opportunistic infections decreases the rate of suppression. Clinicians should therefore reinforce treatment support in patients at great risk of non- suppression.