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Clinic- and individual-level factors that influence HIV viral suppression in adolescents and young adults: a national survey in Kenya.

OBJECTIVES
To determine clinic- and individual-level correlates of viral suppression among HIV-positive adolescents and young adult (AYA) aged 10-24 years receiving antiretroviral treatment (ART).


DESIGN
Multi-level cross-sectional analysis using viral load (VL) data and facility surveys from HIV treatment programs throughout Kenya.


METHODS
We abstracted medical records of AYA in HIV care, analyzed the subset on ART for >6 months between January 2016-December 2017, and collected information on services at each clinic. Multi-level logistic regression models were used to determine correlates of viral suppression at most recent assessment.


RESULTS
In 99 HIV clinics, among 10,096 AYA on ART >6 months, 2,683 (27%) had unsuppressed VL at last test. Among 16% of clinics, >80% of AYA were virally suppressed. Clinic-level correlates of individual viral suppression included designated adolescent spaces (aOR: 1.32, 95%CI [1.07, 1.63]) and faster VL turnaround time (aOR: 1.06 (95%CI: 1.03, 1.09). Adjusting for clinic-level factors, AYA aged 10-14 and 15-19 had lower odds of viral suppression compared to AYA aged 20-24 (aOR: 0.61 [0.54, 0.69] and 0.59 [0.52, 0.67], respectively. Compared to females, males had lower odds of viral suppression (aOR: 0.69 [0.62, 0.77]). Compared to ART duration of 6-12 months, ART for 2-5, >5-10 or >10 years was associated with poor viral suppression (p < 0.001).


CONCLUSIONS
Dedicated adolescent space, rapid VL turnaround time, and tailored approaches for males and perinatally-infected AYA may improve viral suppression. Routine summarization of VL suppression in clinics could provide benchmarking to motivate innovations in clinic- and individual-AYA care strategies.