Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 17:47:8.
doi: 10.1186/s41182-019-0135-z. eCollection 2019.

Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study

Julian Natukunda  1   2 , Peter Kirabira  1 , Ken Ing Cherng Ong  2 , Akira Shibanuma  2 , Masamine Jimba  2
Affiliations

Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study

Julian Natukunda et al. Trop Med Health. .

Abstract

Background: Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10-19 years) receiving antiretroviral therapy (ART) in Uganda.

Methods: We conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients' demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression.

Results: We analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96).

Conclusion: More than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations.

Keywords: Adherence; Adolescents; Antiretroviral therapy; Human immunodeficiency virus (HIV); Viral suppression; Virologic failure.

PubMed Disclaimer

Conflict of interest statement

We obtained a waiver from the International Health Sciences University’s Degree Research and Ethics Committee. The reason for the waiver was that the study had no potential to cause harm whether physical or psychological to the participants. The decision was based on the National Guidelines for Research involving humans as research participants developed by the Uganda National Council for Science and Technology. We also obtained permission from the hospital administration to conduct the study.All participants (adolescents or caretakers) involved in the study gave their consent to use the information collected for publication purposes.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) Ending AIDS; Progress towards 90-90-90 targets. Geneva: UNAIDS; 2017.
    1. World Health Organization . A global research for adolescents living with HIV. Geneva: WHO; 2017.
    1. UNICEF. Analysis of UNAIDS 2016 estimates.
    1. Bulage L, Ssewanyana I, Nankabirwa V, Nsubuga F, Kihembo C, Pande G, et al. Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda August 2014–July 2015. BMC Infect Dis. 2017;17:326. doi: 10.1186/s12879-017-2428-3. - DOI - PMC - PubMed
    1. Boerma RS, Boender TS, Bussink AP, Calis JC, Bertagnolio S, Rinke de Wit TR, et al. Sub-optimal viral suppression rates among HIV-infected children in low-and middle- income countries: a meta-analysis. Clin Infect Dis. 2016; 10.1093/cid/ciw645. - DOI - PubMed

LinkOut - more resources