Factors associated with HIV RNA viral non-suppression among children and adolescents living with HIV attendingpublic health facilities in Gulu city, Uganda

Abstract

Introduction: Viral load testing is the gold standard for anti-retroviral therapy (ART) monitoring. Achieving viral suppression is central to abating HIV complication. Evidence suggests that children and adolescents with HIV (CAWH) have much lower viral load suppression rates. However, data on the incidence of viral load non-suppression(VLNS) and its associated factors among CAWH in Northern Uganda is scarce. Therefore, we assessed the factors associated with HIV RNA viral load non-suppression among CAWH in Gulu city, Uganda. Methods: A retrospective cohort study, utilizing a data abstraction tool to collect information on HIV RNA VLNS at 6, 12, 18, 24 months and at the latest follow-up among 218 CAWH at public facilities in Gulu city. Bivariate and multivariate Cox proportional hazards models were used to identify the factors associated with viral load non suppression. Hazard ratio with 95% CI and p-value were used to assess the strength and statistical significance of association. Results: The median age of the 218 participants was 12.5 (IQR: 7-18) years and majority (70.2%, n=153) were female. A total of 99 (45.4%) had viral load non-suppression during the follow-up period. The overall incidence rate of HIV viral non suppression was 10.3 cases per 100 person-years and the median time to viral non-suppression was 0.49 years. Age<5 years [Adjusted Hazard Ratio (aHR)]:2.59; 95% CI: 1.30-5.17), poor adherence to ART (aHR:1.96; 95% CI: 1.21-3.17), non-disclosure (aHR:2.19; 95% CI: 1.27-3.80), late WHO clinical stage (Stage III and IV) (aHR:3.07; 95% CI: 1.41-6.69), and having economic challenges (aHR:2.13; 95% CI: 1.32-3.42) were significantly associated with viral non suppression. Conclusion: HIV viral non-suppression among CAWH was high. The time to non-viral suppression after ART initiation was 6 months. Intensified monitoring and adherence counselling are required to improve viral suppression rates in this population.