Prevalence and factors associated with virological non suppression among HIV positive adolescents treated with antiretroviral therapy in Apac district

Abstract

Globally, there is an increasing population of adolescents and young people among people living with HIV which require more concentrated focus on adolescents and young people (UNICEF, 2018). High virological non-suppression rates among HIV+ adolescents on ART affect their health status, increase chances of HIV transmission, and ultimately diminish the effort to end the HIV/AIDS epidemic. The main study objective was to determine the prevalence and factors associated with virological non-suppression among HIV positive adolescents treated with antiretroviral therapy in the rural setting of Apac district. This is because there is limited information about virological non suppression and its associated factors among HIV positive adolescents enrolled in HIV care in many resource-limited settings. Retrospective cross-sectional design was used. Data for adolescents aged 10-19 years on ART from July 2016 to June 2017 were reviewed from Apac general hospital, Aduku HC IV and Akokoro HC III. In total, 701 of the adolescents were at least six months on ART. Data was collected using retrospective audit form, entered into Microsoft Excel, cleaned and exported into SPSS version 20 for statistical analysis at 95% Confidence Interval. Univariate (central tendencies, frequencies and percentages), Bivariate (Chi-square, Fisher’s exact test and binary logistic regression) and Multivariate analysis were used to analyse the data. Results: There were 532 valid records of adolescents (10-19 years) on ART. The mean age was 13(±2.67) years, 385 (72.4%) were aged 10-14 years. More than half 320 (60.2%) were females. The prevalence of virological non-suppression was 38.9% (n=207 95%CI: 34.74-43.20). Bivariate analysis showed statistically significant difference between age category (p=0.043), social support (p<0.001), levels of support (p<0.001), peer related influence (p<0.001), clients’ adherence to ART (p<0.001), treatment line (p=0.006), BMI (p=0.009) and HIV clinical stage status (p=0.017) with virological non-suppression. Multivariable logistic regression analysis using stepwise backward elimination modeling showed that adolescents aged 15-19 years (aOR=1.14, 95%CI: 0.63-2.08 p=0.662) contrarily that patients with most support contributed in increasing virological non-suppression (aOR=5.94, 95%CI: 3.82-9.25, p<001). On the other hand, adolescents provided with social support (aOR=0.34 95%CI: .16-.73 p=0.006.), had peer related encouragement (aOR=0.18, 95%CI: .13- .27 p<.001), adherence level of 85-94% (aOR=.36, 95%CI: .13-.99, p<.047*) and <85% (aOR=.29, 95%CI: .15-.59, p=.001) indicating level of reduction increases with increase in level of adherence and HIV clinical stage 3 (aOR=0.33, 95%CI: .19-.59, p<.001) were significantly associated with reduction in non-virological non-suppression. Virological non-suppression was at 38.9%. Adolescents aged 15-19 years and those provided with much support increases virological non-suppression. Adolescents with social support, had peer related encouragement during ART, had adherence of 85-94% and were in HIV clinical stage 3 were significantly associated with reduced virological non-suppression. Health care providers should develop strategies for ensuring all adolescents of all age groups achieve the recommended adherence level to ART, BMI, encourage parents or guardians and peers to provide positive social support and encouragement to adolescents on ART.