Socioeconomic determinants of suboptimal adherence to ART and elevated HIV viral load in twelve Sub-Saharan African countries: evidence from population HIV impact assessment survey data

Abstract

This study identifies factors influencing viral load suppression among HIV-positive individuals in twelve sub-Saharan African (SSA) countries. Maintaining ART adherence and achieving viral suppression are vital for maximizing health outcomes. Understanding these factors is essential for improving HIV management strategies in the region. An analytical cross-sectional study was conducted among twelve SSA countries to assess the factors influencing adherence level and viral suppression among adult HIV-positive individuals. Bivariate and multiple binary logistic regression models were used to examine the relationship between socio-economic factors and viral load levels. Data was extracted from PHIA survey and analysis was conducted by STATA. The study demonstrates that viral load suppression increases significantly with age. Patients aged 36–45 years (OR = 5.68), 46–55 years (OR = 12.46), and 56–65 years (OR = 40.47) showed progressively higher odds of achieving suppression compared to younger individuals. Patients not on antiretroviral therapy (ARVs) were far less likely to achieve viral load suppression (OR = 0.02) than those receiving treatment. Risky sexual behaviors also negatively influenced suppression outcomes, as patients with one partner (OR = 0.00003) or multiple partners (OR = 0.0000968) exhibited markedly reduced odds compared to those practicing abstinence. Similarly, condom use was associated with lower odds of suppression, while abstinence slightly increased the likelihood (OR = 0.000007). Frequent alcohol consumption, particularly four or more times per week, significantly reduced the likelihood of achieving viral load suppression (OR = 0.14) compared to individuals who abstained. The average viral load level per individual is 22,138.27. The study highlights that viral load suppression improves significantly with age, particularly among individuals aged 36–65 years. Antiretroviral (ARV) treatment greatly enhances suppression rates, while risky sexual behaviors and frequent alcohol use hinder progress. This emphasizing the importance of targeted interventions to address behavioral and treatment challenges effectively.