Factors associated with viral suppression and antiretroviral therapy adherence among adolescents and young adults living with HIV in the African Cohort Study.
Aug 2026· Journal of Acquired Immune Deficiency Syndromes· 0 citations
Medicine
TL;DR
Viral suppression and ART adherence were high among AYLHIV in AFRICOS and clinic site and ART regimen were associated with outcomes, highlighting the importance of health system factors.
Abstract
INTRODUCTION
Adolescents and young adults living with HIV (AYLHIV) experience poor outcomes across the care continuum, and most reside in sub-Saharan Africa. The African Cohort Study (AFRICOS) provides an opportunity to examine HIV outcomes in this population across Kenya, Nigeria, Tanzania, and Uganda.
Methods
We conducted a cross-sectional analysis of AYLHIV aged 15-29 years, enrolled in AFRICOS 2013-2023, and on antiretroviral therapy (ART) ≥ six months. Primary outcomes were HIV viremia and 30-day ART non-adherence. Factors included HIV acquisition route, ART duration, ART class, and site. We used multivariate robust Poisson regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Site directors were surveyed to assess youth-friendly services.
Results
Among 656 participants, the median age was 20.0 years (IQR 17.5-23.3); 41.6% were male, 61.6% had perinatally-acquired HIV, and median duration since HIV diagnosis was nine years. At enrollment, 83.8% had viral suppression (<200 copies/mL) and 80.2% were ART adherent. ART regimen and clinic site were associated with viral suppression: youth on integrase vs. protease inhibitor-based regimens (adjusted relative risk (aRR) 0.38, CI 0.23-0.63, p<0.001), and in Uganda (aRR 0.42, CI 0.20-0.90, p=0.026) or Kisumu, Kenya (aRR 0.40, CI 0.22-0.76, p=0.005) had lower likelihood of non-suppression. Compared to Nigeria, participants from other sites were less likely to report non-adherence (unadjusted RR 0.31-0.44). Youth-friendly service provision varied.
Conclusions
Viral suppression and ART adherence were high among AYLHIV in AFRICOS. Clinic site and ART regimen were associated with outcomes, highlighting the importance of health system factors.
BACKGROUND
Adolescents and young adults living with HIV (AYAHIV) aged 15-24 years experience poorer HIV outcomes than other age groups, with frequent interruptions from care. Interruptions during the first year of antiretroviral therapy (ART) are especially concerning, as they occur before sustained viral suppression. We estimated the incidence of early HIV care interruption and associated factors among AYAHIV initiating ART in the Khayelitsha cohort, Western Cape, South Africa.
METHODS
We conducted a retrospective cohort study of AYAHIV initiating ART between 2017 and 2021. Early HIV care interruption was defined as ≥90 days late for a scheduled refill without documented death or transfer. Participants were followed for 12-15 months. Cox proportional hazards models assessed associated factors, adjusting for age, sex, calendar year, dispensing interval (single-month vs multi-month), and regimen among 2020-2021 initiators. A sensitivity analysis was restricted to those with ≥4 refills.
RESULTS
Among 5,149 AYAHIV (85% female; median age 23 years), 44% experienced early interruption, most within six months. Initiation in 2020 (adjusted Hazard ratio (aHR): 1.10, 95% confidence interval (95% CI): 1.03, 1.17) and 2021 (aHR: 1.28 95% CI: 1.18, 1.39) was associated with increased interruption risk versus 2017-2019. Dolutegravir was associated with a reduced risk compared to efavirenz (aHR: 0.87 95% CI: 0.78, 0.97). In sensitivity analyses (n=3,013), 32% interrupted, with similar associations.
CONCLUSIONS
Early HIV care interruption was common, particularly during COVID-19. Dolutegravir was associated with improved retention, yet substantial early interruptions persisted, highlighting the need for intensified youth-focused support following ART initiation.
P. Nyakato, J. Euvrard, Chido Chinogurei et al.· Journal of Acquired Immune D...· 0 citations
Background Adolescents and young adults living with HIV (AYALHIV) in sub‐Saharan Africa have lower viral load (VL) suppression (VLS) rates than older adults. Rwanda lacks national‐level evidence on predictors of VLS in this age group. This study assessed demographic and clinical determinants of VLS among AYALHIV aged 15–24 years on antiretroviral therapy (ART), using national case‐based surveillance (CBS) data. Methods We conducted a retrospective cohort analysis of AYALHIV enrolled in Rwanda’s CBS system who initiated ART between January 2019 and December 2025 and had a documented VL at least six months after ART initiation. The primary outcome, VLS, was defined as VL ≤ 1000 copies/mL. Modified Poisson regression with robust, facility‐clustered standard errors was used to estimate prevalence ratios (PRs); missing covariate data were addressed using multiple imputation (m = 20), pooled using Rubin’s rules. Results A total of 4140 participants across 458 health facilities were included. Most were female (88%) and aged 20–24 years (90.7%); 91.6% were initiated on a dolutegravir‐based regimen, 98.7% demonstrated good adherence, and overall, 96.1% achieved VLS. In multivariable analysis, good adherence was the only factor independently associated with VLS, corresponding to a 70% higher prevalence of suppression relative to bad/moderate adherence (adjusted PR = 1.70; 95% CI: 1.33–2.19; p < 0.001). Conclusion VLS among AYALHIV aged 15–24 years engaged in Rwanda’s HIV care program is high, exceeding the UNAIDS 95% target. Country HIV programs should prioritize adherence‐focused interventions and proactively address underlying barriers to adherence in order to sustain optimal treatment outcomes in this population.
G. Rwibasira, Jean Claude Kwizera, S. Karera et al.· Journal of Tropical Medicine· 0 citations
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.
Josephine Philip Malum, A. Akyala, Y. Ngwai et al.· Journal of Clinical Practice...· 0 citations
Background We characterize antiretroviral therapy (ART) adherence among children and adolescents living with perinatal HIV (CALWH) and investigate its impact on treatment failure (TF) and drug resistance (DR). Methods We enrolled Kenyan CALWH ≤15 years on NNRTI-based ART and monitored adherence over six months, with monthly, validated questionnaires and continuous MEMs (Medication Event Monitoring Systems) electronic dose monitoring. We assessed associations between TF (viral load (VL) >1,000 copies/mL; local guidelines) at 1 month (Blood Draw 1, BD1) and, for a subset, at 4 months (Blood Draw 2, BD2) and adherence using weighted logistic regression. Sanger genotyping identified reverse transcriptase DR mutations upon TF. Associations between number of mutations and adherence was modelled by weighted Poisson regression. Results Among 692 CALWH (51% female; mean 8.4 years) on ART for mean 2.6 years between 2010−2013, 44% reported non-adherence at baseline. At BD1, 21% (N = 143/464) had TF. Reported non-adherence at enrollment and lower MEMS adherence between enrollment and BD1 were significantly associated with TF at BD1 (respectively, OR=1.25 per 1 unit higher non-adherence, 95% CI = 1.05 to 1.48, and OR=0.69 per 1 unit z-score higher MEMS adherence, 95% CI = 0.50 to 0.95). Among those with TF at BD1, 43% (31/72) had TF at BD2, higher MEMS adherence no longer predicted VL suppression. DR genotyping among those with TF at BD1 found fewer mutations for those without treatment interruption >48 hours (RR = 0.17, CI = 0.05 to 0.61), but among them, more mutations for those with longer interruptions (hours, log-10 RR = 2.48, CI = 1.10 to 5.59). More resistance was also associated with longer ART years (Log-10 RR = 1.47, CI = 1.15 to 1.89), and higher log-10 VL at BD1 (RR = 1.21, CI = 1.06 to 1.37)). MEMS adherence had significant, U-shaped relationship, with most mutations at lower (<50%) adherence. Conclusion Well characterized non-adherence among Kenyan CALWH was common and resulted in increased risks for TF and extensive DR, highlighting treatment challenges.
Introduction: Optimal adherence to antiretroviral therapy (ART) is essential for viral suppression, yet the factors driving adherence among youth in rural Ugandan settings remain incompletely documented. This article, drawn from a wider study, examined the factors associated with ART adherence among youth receiving long-term ART in selected Health Centre IVs in Isingiro District, Uganda.
Methods: A cross-sectional design employing a mixed-methods approach was used. Quantitative data were collected from 243 youths aged 18–30 years on ART using a structured questionnaire, while qualitative data were obtained from three counsellors and three peer educators through in-depth interviews. Bivariate ordinal logistic regression screened variables at p<0.10 within four factor domains (social support, individual, drug-related, and health facility), and significant variables were entered into domain-specific multivariate binary logistic regression models. Qualitative data were analysed thematically.
Results: Active peer co-engagement in HIV services and open medication communication were the strongest social predictors of adherence. Absence of a family drug/pill companion (AOR=0.22, 95%CI=0.11–0.47, p=0.001) and alcohol consumption were the leading individual-level predictors. Treatment fatigue, operationalised as second thoughts about continuing ART, was the dominant drug-related predictor (AOR=3.58, 95%CI=1.71–7.50, p=0.001). Delayed attendance at the health facility was the only significant health-system predictor (AOR=4.32, 95%CI=1.29–14.41, p=0.017).
Conclusion: ART adherence among youth is shaped by an interacting web of family support, treatment fatigue, and health-system efficiency, rather than by any single dominant factor.
Recommendation: Programmes should formalise family pill-companion support, integrate motivational counselling to address treatment fatigue, and prioritise appointment-system reforms to reduce facility delays.
Kalega William, Otwine Anne, J. Amanyire· International Journal of Sci...· 0 citations
Background: Human Immunodeficiency Virus (HIV) continues to pose a major global public health challenge, especially in low and middle income countries. Sustained adherence to Antiretroviral Therapy (ART) is fundamental to achieving viral suppression, preventing disease progression, and reducing transmission. Despite advances in treatment availability, suboptimal adherence continues to hinder optimal clinical outcomes.
Aims: This study aimed to examine the key determinants influencing ART adherence among people living with HIV (PLHIV) in North Sumatra, Indonesia.
Methods: A quantitative cross-sectional study was conducted from April to December 2024 at Dr. Ferdinand Lumbantobing General Hospital, Sibolga City. All 88 PLHIV receiving ART during the period were recruited using total sampling. Data were collected via structured questionnaires and analyzed using univariate analysis, chi-square tests, and multivariate logistic regression to identify significant adherence predictors.
Results: ART adherence was significantly associated with treatment-related knowledge, family support, healthcare provider support, and access to healthcare facilities (p < 0.05). Multivariate logistic regression revealed that treatment knowledge was the most influential determinant of adherence, followed by family support, healthcare provider support, and healthcare accessibility.
Conclusion: ART adherence in this tropical setting is shaped by a dynamic interplay of individual understanding and social and healthcare system support. Strengthening patient education, fostering family engagement, and improving access to healthcare services are essential strategies for sustaining treatment adherence over time. Future longitudinal research is warranted to explore adherence trajectories and evaluate targeted intervention models
Lidya C. M. Hutapea, T. Widyawati, Rodiah Rahmawaty Lubis et al.· Jurnal Kesehatan· 0 citations
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