Factors associated with viral suppression among HIV-Positive adolescents that have transitioned from adolescent to adult clinic services at Mild-May-Uganda

Abstract

Background The introduction of antiretroviral therapy (ART) has significantly decreased paediatric mortality from HIV/AIDS, changing its course from once a fatal disease to a chronic one. As a result, perinatally infected children are surviving into adulthood, creating a need to transition adolescents living with HIV from paediatric/adolescent clinics to adult care. To sustain viral suppression while receiving ART, individuals living with HIV/AIDS must remain engaged in medical care and maintain high adherence to medical regimens. Adverse health outcomes, especially non-viral suppression among HIV infected adolescents /youth after the transition to adult clinic, has raised concerns. There is a paucity of data on factors associated with viral suppression post-transition in our setting. Objective To determine the factors associated with viral suppression among adolescents living with HIV that have been transitioned from adolescent HIV clinic to adult HIV clinic at Mild-May Uganda between January 2018 to January 2020. Methods A quantitative study with two study designs was conducted at Mildmay-Uganda among 386 adolescents who had transitioned to the adult clinic between January 2018 and January 2020. A retrospective study design was used for objectives one and two. For objective number three, a cross-sectional study design was employed to determine factors associated with viral suppression among adolescents living with HIV who had undergone the transition to adult care. A study-specific questionnaire and clinic abstraction form were used to obtain demographic, clinical, socio-economic, and psychosocial data. The data was entered in epi data version 4.2 and analyzed using STATA 14. Descriptive statistics and multivariate logistic regression analyses were done. Results The number of adolescents transitioned from adolescent to adult clinics between January 2018 and January 2020 was 397 representing (47.6%) of the eligible adolescents for transition. The median age for transition was 22 years with IQR (21-23 years). The viral suppression rate among the transitioned adolescents was 84% (CI: 80.8-88.1). The factors associated with viral suppression were;having one parent alive (AOR 5.3,CI 5.3-21.3,p-value 0.019) being married or in a cohabiting relationship (AOR 7 ,CI: 1.2-32.7,P-value 0.028),), not missing ART dose in the last seven days (AOR 4.6, CI: 1.4-15,p-value 0.049),attending all clinic appointments (AOR 17,CI 3.8-76 p-value <0.001),Missing only one clinic visit xii (AOR 7.6,CI 2-29.7 P-value 0.003) and being on first line ART(AOR 5.8 CI 1.6-20.p-value 0.0071) Conclusion and recommendations The viral suppression rate among the transitioned adolescents of 84% reflected a better viral suppression rate compared to the national average. However, the figure was less than the general suppression rate among adolescents at Mildmay and fell short of the UNAIDs 95-95-95 global targets. Adherence to ART was the most important factor associated with achieving viral suppression. To achieve the 95% global target by 2030,adolescents that have been transitioned to the adult clinic should be accorded psychosocial support to improve self efficacy and self competence so that they are able to adhere to their ART medications and subsequently improve their viral load suppression. The close family members to the adolescents should be provided with adequate information,training and resources to facilitate their effectiveness in supporting adolescents’ adherence to their treatment. There is need for a larger prospective study to assess other social,cultural and economic factors that affect viral load suppression in this group. Key words: HIV, Adolescent, Transition, Viral suppression