| dc.description.abstract | Introduction: Compared to HIV positive non-refugee adolescents, refugee adolescents are generally less likely to receive antiretroviral therapy, and access to the drugs is often inconsistent (UNHCR, 2015). This study aimed to identify factors associated with viral non-suppression among refugee adolescents after at least six months of ART initiation, along with viral suppression and retention rates.
Main Objective: The purpose of this study was to determine the retention in care, the level of viral non-suppression, and identify the factors associated with viral non-suppression among refugee adolescents infected with HIV at Kyangwali re-settlement settlement.
Methods: A cross-sectional study of 246 HIV-positive refugee adolescents conducted between June to November 2021. These are adolescents registered on ART for at least 6 months and with at least one documented viral load in the last 12 months in Kyangwali refugee settlement in Kikuube district. Socio-demographics, clinical history, and treatment outcomes were collected using a questionnaire. Viral load status from routine medical records were used to determine treatment outcome. Epi-data software was used to enter the data, and STATA was used for both bivariate and multivariable logistic regression analyses to identify factors associated with viral non-suppression.
Results: Seventy-eight per cent (78%) of refugee adolescents achieved viral suppression. The viral suppression rates in this group was below UNAIDS' 95-95-95 targets. After six months on ART, 83.8% of respondents were still in care. This is significantly low when compared to national suppression rate for HIV positive adolescents. At bivariate logistical regression analysis level, adolescents (15-19) (crude Odds Ratio (OR) =2.1, 95% CI 1.05 - 4.16), males (crude OR =3.6, 95% CI 1.91 – 6.82), living 5 kms from the health facility (crude OR =2.3, 95% CI 1.25 – 4.30), not living with one’s parents (crude OR =2.3, 95% CI 1.10 – 4.87), history of TB disease (crude OR =4.7, 95% CI 1.73 – 12.10), intake of alcohol (crude OR =7.4, 95% CI 2.93 – 18.56) and adherence to ART (crude OR =3.8, 95% CI 1.59 – 9.13) were statistically significant with viral non-suppression.
After multivariable logistical regression analysis, living at a distance greater than 5 kms from the health facility (Adjusted Odds Ratio (AOR) = 2.5, 95% CI: 1.2 – 5.3), history of TB disease (AOR = 3.4, 95% CI: 1.07 – 10.6), intake of alcohol (AOR = 3.2, 95% CI: 1.0 – 9.9), poor adherence to ART (AOR = 3.6, 95% CI: 1.26 – 10.5) were statistically significantly associated with viral non-suppression.
Conclusion: Viral suppression among refugee adolescents is still below the target of 95%. Retention in care is suboptimal as well. Poor adherence to ART medication is strongly associated with viral non-suppression. The study shows that consuming alcohol, TB disease, having to travel long distances to access ART contribute significantly to the viral non-suppression in the refugee adolescents. Interventions are needed to ensure prompt intensive adherence counselling for adolescents with poor ART adherence, screening for TB as well as alcohol intake regularly, initiating TB preventive Therapy for all adolescents with negative TB screen. | en_US |
