SUB-OPTIMAL HIV VIRAL SUPPRESSION AND ITS DETERMINANTS AMONG ADOLESCENTS IN THE POST-VIRAL LOAD MONITORING SCALE-UP ERA IN MULAGO ISS CLINIC AND BWIZIBWERA HIV CLINIC IN UGANDA

Abstract

Background: Four years since the routinization of viral load monitoring and associated support for ART clients in Uganda, viral suppression in the adolescents aged 10-19 is still low at 73.7%. There is limited knowledge of the factors associated with sub-optimal viral suppression within adolescents in resource-limited countries in the context of routine viral load monitoring. This study sought to examine the factors associated suboptimal viral suppression among adolescents on ART in Uganda in the post-routine viral load monitoring scale-up era

Methodology: This cross-sectional study was conducted on adolescents 10-19 years old living on ART in two large HIV clinics in Uganda namely: Mulago ISS Clinic and Bwizibwera Health Centre IV. The study employed a convergent parallel mixed methods design. The quantitative arm involved a logistic regression analysis to assess the relationship between viral suppression status and associated factors, with sub-optimal viral suppression defined as >1000 copies/ml. The qualitative arm involved key informant interviews with adolescent peers and in-depth interviews with sub-optimally suppressing adolescents.

Results: From 183 adolescents interviewed, 23 (12.6%) of them had sub-optimal viral suppression. A one year increase in age was significantly associated with a 33% reduction in the odds of sub-optimal viral load suppression (AOR 0.67; p=0.012). When compared to adolescents with a low adherence, the odds of sub-optimal viral suppression among adolescents who had an average adherence were reduced by 94% (AOR, 0.06; p=0.025), and by 98% (AOR, 0.02; p=<0.001) among those who had a high adherence. Adolescents who reported that the ART clinic waiting area was suitable for their care had odds of sub-optimal viral suppression reduced by 86% (AOR, 0.14; p=0.028); while those who had never experienced ARV stock outs had their odds reduced by 99% (AOR, 0.01; p=0.031) when compared to those who had experienced ARV shortages 1-2 times.

Conclusion and Recommendations: The prevalence of sub-optimal viral suppression among adolescents in Uganda is still yet to met the UNAIDS 90-90-90 by 2020 targets. The younger the adolescent, the more support they need to enable them achieve viral suppression. Adherence-related challenges need to be addressed for optimal adolescent ART services. Adolescent-friendly services should be offered by all clinics caring for adolescents living with HIV. Health workers should strengthen the supply chain system to ensure an uninterrupted availability of ARVs for efficient adolescent HIV service delivery.