Correlates of Virological non-suppression among children and adolescents aged 5-19 years on Dolutegravir based regimens attending Gulu Regional Referral Hospital, Northern Uganda : a mixed methods cross-sectional study

Abstract

Background: HIV/AIDS remains the leading cause of mortality and morbidity among children and adolescents living with HIV/AIDS and Sub-Saharan Africa bears the burden of virological non-suppression with children and adolescents being disproportionately affected. Viral suppression has been sub-optimal among children and adolescent in Uganda, despite a near universal transition to the much effective Dolutegravir-based regimens. Therefore this study was aimed at determining the prevalence of virological non-suppression and its associated correlates among children and adolescents aged 5-19 years on Dolutegravir-based regimens. Methods: A mixed methods cross-sectional study was conducted among 303 children and adolescents aged 5-19 years on Dolutegravir-based regimens from January 2021 to December 2022. Consecutive sampling was used. Existing medical records and data on socio-demographic and clinical characteristics were extracted during quantitative interviews and file reviews. The primary outcomes were prevalence and correlates associated with virological non-suppression. Chi-square likelihood ratio at p value of ≤ 0.05 and Modified Poisson regression analyses were done using STATA version 14.0 to identify correlates significantly associated with virological non-suppression at 95% confidence interval and p-values of ≤ 0.20 at bivariate analysis and ≤ 0.05 at multivariate analysis. Purposive and convenient sampling was done to identify key informant and in-depth interview participants respectively, to provide broad explanations on associated correlates of virological non-suppression and data was analyzed using manual thematic content analysis. Results: Virological non-suppression prevalence was 12.2% (95% CI: 8.5% - 16.0%). After adjusting for other correlates, the correlates of virological non-suppression were; Parental status (being single orphan, aPR: 5.4 [95% CI: 1.81 - 15.90], p = <0.001), (double orphan, aPR: 3.3 [95% CI: 1.07 - 10.02], p = 0.04), Clinical stage (WHO clinical stage II on Dolutegravir-based anti-retroviral therapy initiation (aPR: 3.4 [95% CI: 1.55 - 7.62], p = <0.001), and Malnutrition status (moderate acute malnutrition (aPR: 2.3 [95% CI: 1.16 - 4.76], p = 0.02). Differentiated service delivery models, multi-month drug dispensing tolerability and palatability of Dolutegravir, adolescent child friendly services, awareness and stigma reduction programs, having a caregiver and having a caregiver who is on anti-retroviral therapy emerged as important deterrents to virological non-suppression. However, HIV status non-disclosure, food unavailability, deprivation of family and social support, secondary school age, poor adherence, malnutrition, depression, tuberculosis co-infection, disease progression to stage II and above, drug holidays and fatigue, transitioning from child to adolescent age and information gap on treatment were potential enablers of virological non-suppression. Conclusion: The prevalence of virological non-suppression among children and adolescents aged 5-19 years on Dolutegravir-based regimens was 12.2%. This was relatively low compared to other studies conducted in Uganda and other Sub-Saharan African countries but short of the UNAIDS third 95% target for viral suppression.