Prevalence and factors associated with viral load suppression among adolescents living with HIV in Rwanda, 2019-2021

Abstract

Background: The goal of antiretroviral therapy is to achieve sustained human immune deficiency virus (HIV) viral suppression. However, research on the prevalence and factors associated with viral load suppression among adolescents in low and middle-income countries is limited. The objectives of this study were to determine the prevalence and factors associated with viral load suppression among adolescents living with HIV in Rwanda.

Methods: A retrospective study used data from all public health facilities in Rwanda providing services to Adolescents Living with HIV (ALHIV) and who are regularly reporting in Viral Load Sample Management System (VLSMS) from January 2019 to December 2021. Binary logistic regression was used to determine factors that influence viral load suppression among participants, then Odds Ratios (ORs) and 95% C.I were reported. Results were significant at 95% confidence level. Data were analysed using STATA software version 16.

Results: Out of 10,615 participants, 86.9% had achieved HIV viral suppression (<1,000 copies of viral RNA/mL of blood). After adjusting for other covariates, adolescents with good adherence to ART (AOR=4.5, 95% C.I: 3.6-5.7), receiving care and treatment at hospital level (AOR=1.3, 95% CI=1.1-1.5), between the age of 15 to 19 (AOR=1.1, 95% CI=1.0-1.3), receiving second or line ART regimen (AOR=0.4, 95% CI=0.3-0.4), residing in Western province (AOR=0.7;95% CI: [0.5-0.9]; p=0.01), and Eastern province (AOR= 0.7; 95% CI: [0.6- 0.9]; p=0.026) were significantly associated with viral load suppression in ALHIV.

Conclusion: The findings indicate that viral suppression among ALHIV on ART was at 86.9% and this proportion is below the UNAIDS 2030 target set at 95%. The findings indicate that having good adherence to ART, receiving care from hospital level, being an adolescent between the age of 15 to 19 contribute in attaining viral load suppression. However, ALHIV on 2 nd or 3rd line treatment have a risk of viral load non suppression. Strengthening adherence and support program, care and treatment programs at health centre level, development of age and location appropriate interventions and an individualized care support for ALHIV on 2nd or 3rd line ART regimen are the main recommendation of this study