Antiretroviral Therapy Adherence and Treatment Duration as Predictors of Viral Load Suppression among Children and Adolescents in Nasarawa State, Nigeria

Abstract

Children and adolescents on antiretroviral therapy (ART) are safe, but viral-load non-suppression is still a huge risk to health and survival. The general objective of this study was to estimate the rate of viral load non-suppression and to determine factors associated with it among children and adolescents (0-19 years) on ART in 6 LGAs in Nasarawa State, Nigeria. The study design was an analytical cross- sectional study with structured interviews with participants/caregivers and abstraction of clinical records. Data from 564 participants were obtained and analysed using descriptive statistics, the chi-square test, crude and risk ratios, with the absolute prevalence difference at P< 0.05, and a multivariable logistic regression was also performed. Overall, 497 participants (88.1%; 95% CI: 85.2–90.5) were virally suppressed, whereas 67 (11.9%; 95% CI: 9.5–14.8) were unsuppressed. Participants with good adherence had significantly higher suppression than those with poor adherence (93.7% versus 69.4%), a 24.3-percentage-point difference. Other than the differences above, HIV suppression did not differ between current people living with HIV and 'recent' initiators of ART (those with at least six months' HIV treatment). Adjustment for household income revealed that after it, ART duration ≥ six months (aOR = 6.68; 95% CI: 1.69–26.70), was an independent predictor of high odds of suppression, while poor adherence was an independent predictor of low odds of suppression (aOR = 0.15; 95% CI: 0.05–0.43). Hence, there is a need for increased compliance counselling and early follow-up, together with the sustainable delivery of uninterrupted treatment.