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. 2020 Jun 1;34(7):1065-1074.
doi: 10.1097/QAD.0000000000002538.

Clinic-level and individual-level factors that influence HIV viral suppression in adolescents and young adults: a national survey in Kenya

Irene Njuguna  1   2 , Jillian Neary  2 , Caren Mburu  3 , Danae Black  2 , Kristin Beima-Sofie  4 , Anjuli D Wagner  4 , Cyrus Mugo  1   4 , Yolanda Evans  5 , Brandon Guthrie  2   4 , Janet Itindi  6 , Alvin Onyango  3 , Laura Oyiengo  7 , Barbra A Richardson  4   8 , Dalton Wamalwa  3 , Grace John-Stewart  2   4   9   10
Affiliations

Clinic-level and individual-level factors that influence HIV viral suppression in adolescents and young adults: a national survey in Kenya

Irene Njuguna et al. AIDS. .

Abstract

Objectives: To determine clinic-level and individual-level correlates of viral suppression among HIV-positive adolescents and young adult (AYA) aged 10-24 years receiving antiretroviral treatment (ART).

Design: Multilevel cross-sectional analysis using viral load data and facility surveys from HIV treatment programs throughout Kenya.

Methods: We abstracted medical records of AYA in HIV care, analyzed the subset on ART for more than 6 months between January 2016 and December 2017, and collected information on services at each clinic. Multilevel logistic regression models were used to determine correlates of viral suppression at most recent assessment.

Results: In 99 HIV clinics, among 10 096 AYA on ART more than 6 months, 2683 (27%) had unsuppressed viral load at last test. Among 16% of clinics, more than 80% of AYA were virally suppressed. Clinic-level correlates of individual viral suppression included designated adolescent spaces [aOR: 1.32, 95% CI (1.07-1.63)] and faster viral load turnaround time [aOR: 1.06 (95% CI 1.03-1.09)]. Adjusting for clinic-level factors, AYA aged 10-14 and 15-19 years had lower odds of viral suppression compared with AYA aged 20-24 years [aOR: 0.61 (0.54-0.69) and 0.59 (0.52-0.67], respectively. Compared with female patients, male patients had lower odds of viral suppression [aOR: 0.69 (0.62-0.77)]. Compared with ART duration of 6-12 months, ART for 2-5, above 5-10 or more than 10 years was associated with poor viral suppression (P < 0.001).

Conclusion: Dedicated adolescent space, rapid viral load turnaround time, and tailored approaches for male individuals and perinatally infected AYA may improve viral suppression. Routine summarization of viral load suppression in clinics could provide benchmarking to motivate innovations in clinic-AYA and individual-AYA care strategies.

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Conflict of interest statement

Conflicts of interest

There are no conflicts of interest.

Figures

Fig. 1.
Fig. 1.. Individual-level correlates of viral suppression stratified by age and sex.
Panel a: stratified analysis age-group comparing sex, mode of HIV transmission, antiretroviral (ART) regimen and ART duration between adolescents and young adults with and without viral suppression. Estimates are presented as odd ratios (ORs). Total populations and percentages are presented. Panel b: sex-stratified analysis comparing age, mode of HIV transmission, ART regimen and ART duration between adolescents and young adults with and without viral suppression. Estimates are presented as ORs. Total populations and percentages are presented.
See this image and copyright information in PMC

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