Determinants of Viral Load Un-suppression Among Adolescents Living with HIV in Care, Western District, Harare City, 2023

Abstract

According to World Health Organization (WHO, 2016), recommended viral load is the measure of viral treatment adherence and efficacy. A stable patient on ART whose viral load is suppressed is defined as having success to treatment noted by a threshold of VL<50 copies/ml and has been on treatment for at least 6 months, having no current opportunistic infections, and should have a good understanding of life long adherence (MOHCC, 2016). Measures of the virology outcomes are very essential as adolescents have unique behaviors, which may lead to poor adherence to ART, hence leading to drug resistance, viral load un-suppression and ultimately morbidity and mortality. In Harare Western district viral load un-suppression increased from 13.2% to 22.3% and it is against this background that we identified the determinants of viral load un-suppression which include socio-demographic, client, ART regimen, related factors and HIV/AIDS knowledge levels among adolescents living with HIV in care, assessing the availability of anti-retroviral medicines, and viral load monitoring services for adolescents living with HIV in care in this district. A 1:1 unmatched case-control study was conducted and the source population of this study came from all adolescents aged between 10-19 years and had been receiving HIV treatment care at Harare Western District clinics for at least 6 months. Participants were identified from records at the study sites and systematic sampling was done to obtain 78 controls and 78cases. Data was collected using an interviewer administered structured questionnaire and a key informant interview guide and the following results were obtained. Most of the cases 45/78 (57.7%), and controls 42/78 (53.9%) were female. The median age for cases and controls in years was 14.9 (14.4-16.5), and 15.7 (14.8-16.7) respectively. The only independent risk factor associated with viral suppression was having reported treatment fatigue AOR=4.84 (2.01 – 13.90). The protective factors were; being in an adolescent club [AOR=0.24: 95% CI (0.11 – 0.67)], being on first line ART [AOR=0.63: 95% CI (0.49 – 0.90)], and taking ART once a day [AOR=0.23: 95% CI (0.07 – 0.72)]. Medicines were available and there was robust viral load monitoring system in place in the whole district. In conclusion, this study offers valuable insights into the multifaceted determinants of viral load un-suppression among adolescents living with HIV in the Western District of Harare City. The findings highlight the importance of a holistic, patient-centered approach to HIV care and management. We therefore, recommend that program counselors should work closely with adolescents as well as their close family members so as to ensure a successful viral load suppression.