Determinants of viral suppression to undetectable levels among a cohort of Kenyan adolescents and youths aged 15-24 years

Abstract

Introduction The study evaluated factors that influence viral suppression among adolescents and youths living with HIV (AYLHIV) and described the historical context of their mental health, treatment behavior, and treatment outcome. It emphasized the significance of addressing mental health, stigma, social support, and Harmful alcohol use in enhancing treatment outcomes. Using standardized survey tools and retrospective data collection over one year, the research aimed to discern a one-year trend and assess the effectiveness of psychosocial interventions in promoting viral suppression. Methods We evaluated factors that influence viral suppression among AYLHIV and described the historical background of their mental health, treatment behavior, and treatment outcome using two complementary study designs nested within an ongoing HPV study. The study was performed in Thika, Kenya from October 2023 to March 2024. A cross-sectional study design was used to determine the burden and association of psychosocial factors on viral suppression in a cohort of AYLHIV, and a retrospective cohort study design was used to describe mental health status, treatment behaviors, the impact of interventions, and treatment outcomes over one year. We administered validated survey questionnaires to 146 adolescents and youths on psychosocial factors related to viral suppression. AYLHIV) were asked to complete the PHQ-9 questionnaire, HIV Stigma Scale (HSS), Multidimensional Scale of Perceived Social Support (MSPSS), and Alcohol Use Disorders Identification Test (AUDIT) to determine the prevalence of depressive symptoms, perceived stigma, perceived social support, and harmful or hazardous alcohol drinking habits, respectively. We used the most current data on viral loads obtained within the three months of the survey's administration. Using both univariate and multivariate Poisson regression models, we evaluated the association between alcohol use, viral suppression, depression, stigma, and social support and calculated the relative ratio. For the retrospective cohort design, we extracted data from the 146 participants’ routine medical records. We examined the Patient Health Questionairre-9 (PHQ-9) for depressive symptoms, any history of skipped medication within the previous two weeks, any completed interventions (e.g., adherence counseling, psychosocial counseling, and referrals depending on the severity of depressive symptoms), viral load measurements at baseline and month-12. To summarize the trends over the one year, we examined treatment outcomes such as PHQ-9 scores, viral load results, and missed pills in the last two weeks at baseline, and compared with the same results at month 12. Results A total of 146 AYLHIV were enrolled. The median age was 22 years [Interquartile Range (IQR): 21-23 years), 139/146 (95.2%) were aged between 20 to 25 years, and more than half were female (75/146, 51.4%). Overall, 71.2% (95% CI: 63.9 - 78.5) achieved viral suppression at baseline and 119/146 (81.5%, 95%CI: 75.2 – 87.8) achieved at month 12. Overall, 14.4% (95% CI: 8.3 – 19.6) had mild/moderate depression symptoms, 58.0% (95% CI: 50.9 – 66.9) experienced high levels of HIV-perceived stigma, while only 1.4% (95% CI: 0.0 – 3.3) had low perceived social support. Additionally, 7.5% (95% CI: 3.2 - 11.8) had harmful or hazardous alcohol drinking habits. There was no statistically significant association between psychosocial factors and viral suppression on further analysis. At the start of the study, 13% of participants had depressive symptoms, 9.6% had missed taking their pills in the past two weeks, and 23.3% had received interventions. By the end of 12 months, the proportion of participants with depressive symptoms had decreased to 9.6%. However, the proportion of those who missed pills in the last two weeks had increased significantly to 27.4%. Additionally, the proportion of participants who received interventions had risen to 43.2%. Among the 146 AYLHIV, 34 received interventions at enrollment, while 63 received interventions at month 12. There was an increase in the proportion of AYLHIV who achieved viral suppression after receiving interventions from 55.6% at enrollment to 66.7% at month 12. ConclusionOur study provides valuable insights into the complex interplay between psychosocial factors and viral suppression among AYLHIV. Our findings highlight the prevalence of mental health issues, HIV stigma, social support, and alcohol dependence among AYLHIV. Notably, while a significant proportion reported high levels of social support, a considerable number experienced depressive symptoms and perceived HIV-related stigma.