Challenges Faced by Perinatally-Infected Kenyan Adolescents and Youth Living with HIV During the COVID-19 Pandemic

Abstract

Wellness challenges experienced by adolescents and youth living with HIV (AYLWH) during COVID-19 are unknown and could guide HIV care in resource-limited settings. Between February/2021 and July/2022, perinatally-infected AYLWH at the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya completed surveys assessing psychological, physical, socioeconomic, and antiretroviral nonadherence challenges and underwent viral load (VL) testing evaluating for virologic (VL > 40 copies/mL) or treatment (VL > 1,000 copies/mL) failure. Patterns in challenges, nonadherence, and VL measures by enrolment were evaluated using general additive models. Associations between challenges and nonadherence scores were quantified using linear regression; associations between non-adherence and failure were quantified using logistic regression. Both were adjusted for age, gender, and clinic. Among 442 participants enrolled in this cross-sectional study (median age 17 years, 49% female), 89% reported challenges (48% psychological, 66% physical, 62% socioeconomic) and 74% reported nonadherence. Significant between-individual variations by enrolment date were noted in physical challenges (e.g., illnesses and hospitalizations). Reporting more psychological, physical, or socioeconomic challenges were each associated with higher nonadherence. Higher nonadherence was associated with virologic and treatment failure (OR = 1.22 per 1-unit higher nonadherence, 95% CI = 1.01-1.47, p < 0.036; and OR = 1.29, 95% CI = 1.01-1.64, p < 0.035, respectively). Kenyan AYLWH faced psychological, physical, and socioeconomic challenges during the COVID-19 pandemic. Although longitudinal studies are needed to determine whether these challenges exceed pre-pandemic levels or contribute to the observed increased antiretroviral nonadherence and treatment failure, our findings provide support for the important relationships among these measures and may help clinicians and caregivers identify opportunities for interventions to support this vulnerable population.

Keywords: Adolescents; Antiretroviral adherence; COVID-19; HIV; Low-resource setting.

Figure 1.

Trajectories of challenges and nonadherence measures across enrollment months. This figure represents the relative effect of interview month (X-axis) on individual wellness challenges (Y-axes; psychological-panel A; physical-panel B, socioeconomic-panel C), antiretroviral nonadherence (panel D), viral failure (panel E) and treatment failure (panel F) over the study months (X-axes). Sample sizes of enrollments for each month are represented by the thickness of the black lines on the X-axes. Upper and lower standard errors are represented by the dashed lines.