School Related Factors Associated with Viral Non-Suppression Among Adolescents Living with HIV in Kenya

Abstract

Objectives To evaluate school-related factors associated with viral non-suppression among adolescents living with HIV (ALH) aged 14-19 attending HIV care in Kenya. Design Cross-sectional analysis using survey data and abstracted medical records across 20 HIV clinics in Kenya. Methods We surveyed ALH enrolled in care and abstracted viral load (VL) and clinical data from medical records. Poisson regression models with robust standard errors were used to determine correlates of viral non-suppression (defined as viral load >1000 copies/ml) among ALH overall, and in stratified analyses among boarding and day students. ResultsAmong 812 ALH with available VL results, (80 [10%]) were virally non-suppressed and 39% had any detectable viral load. Twenty-three percent of ALH were attending boarding school. Viral non-suppression was significantly associated with self-reported missed antiretroviral therapy (ART) doses in past month (PR 2.27[1.38,3.72] p=0.001) missed visits in last 6 months (PR 2.19[1.34,3.57] p=0.002) and mild depression (PR 2.28[1.25,4.14] p=0.007). Viral non-suppression was significantly less frequent in those on DTG regimens (PR 0.43[0.23,0.82] p=0.01). Compared to ALH with monthly appointments, those with 3-monthly clinic appointments had a lower prevalence of viral non-suppression (PR 0.37 [95% CI: 0.23,0.62] p=0.001). Among ALH in boarding school, needing to attend clinic when in school and a higher social support score were associated with a lower prevalence of viral non-suppression (PR: 0.38 [95% CI:0.15,0.96] p=0.04) and (PR: 0.96 [95% CI:0.19, 1.05], p=0.04), respectively. Among those in day school, needing to attend clinic when in school, missing clinic appointments, being in a school that tracked ART adherence and mild/moderate to severe depressive symptoms were associated with a higher prevalence of viral non-suppression (PR:2.02 [95% CI:1.08,3.77], p=0.03, PR: 2.45 [95% CI:1.35, 4.34], p=0.003, PR: 2.52, 95% CI: 1.01,6.27, p=0.05 and PR: 2.26 95% CI:1.10, 4.63 p=0.03, respectively). ConclusionSupport to ensure medication adherence, adherence to clinic appointments, and interventions to improve mental health among school-going ALH may improve clinical outcomes. Cofactors for viral non-suppression differed for boarding and day students, suggesting that interventions should be tailored for school context.