VIRAL LOAD SUPPRESSION AND FACTORS ASSOCIATED WITH HIV VIRAL SUPPRESSION AMONG ADOLESCENTS ON ANTIRETROVIRAL THERAPY IN LIRA REGIONAL REFERRAL HOSPITAL

Abstract

Introduction In 2018 about 1.4 million people were estimated to be living with HIV in Uganda, 6% (89,664) of these were adolescents (10 - 19 years). However, despite the improved access to antiretroviral therapy and viral load testing globally and in Uganda, viral load suppression among adolescents (73%) is still low compared to adults (93%). This high HIV prevalence in Lira region of 7.2% and low VL suppression puts the adolescents at risk of transmitting HIV to their partners and acquiring opportunistic infections which may result into death. Hence making HIV the leading cause of death among adolescents in sub-Saharan Africa. Objective: The objective of the study was to determine viral load suppression rates and factors associated with viral suppression among adolescents receiving ART at Lira Regional referral hospital. Methods; This was a concurrent mixed-methods cross-sectional study, conducted at Lira Regional Referral Hospital. A total of 404 adolescents aged 10-19 years were enrolled in the study. Data was collected using semi- structured questionnaires, entered in EPI DATA software version 3.1. and analysis of three hundred eighty-four (384) done using STATA version 13. Twenty (20) were incomplete lacked information on viral load, thus were excluded from the analysis. For the qualitative part, 6 key informant interviews (KII) and 24 in depth-interviews (IDI) were conducted with health workers and parents/ caregivers respectively to explore factors influencing viral load suppression. Qualitative data were recorded verbatim, transcribed and analyzed in themes Results Majority of the adolescents were girls (52.5%) and had a median (IQR) age of 13(12,16) years. More than sixty percent (64.1 %) were young adolescents (10- 14 years), 88% were residents of Lira district and 94.3 % were school going. Of those in school, 63.5% were primary level learners. Of the non-school going (%) only 1 was employed. The viral load suppression rate was 78.1. The factors associated with VL suppression were; CD4 count >500; PR 1.22 (95% CI 1.07,1.38), the care taker’s level of education; PR 1.18 (95 % CI 1.05,1.33) and VL at baseline; PR 2.99 (95% CI 2.15,4.15). At multivariate analysis only VL suppression at baseline remained significantly associated with suppression; Adjusted PR 2.92(95 % CI 2.10,4.05) Conclusion: More than three quarters of the adolescents were virally suppressed. This level is lower than the UNAIDS country target of 90 %. The only independent predictor was viral load suppression at baseline viral load. Poor time management and lack of parental support were key issues reported by adolescents to affect their adherence to treatment and hence non VL suppression. Recommendation: To address the low suppression rates, the Ministry of health should strengthen the implementation of the National HIV care and treatment with an emphasis on viral load monitoring, WHO staging assessment and baseline CD4 testing as routine practice prior to ART initiation. The health workers should involve adolescents and their parents and caretakers(families) in developing the care and treatment plans for the adolescents and encourage parents to provide the basic needs and psychosocial support.