Factors Associated with Poor Viral Suppression Among Children and Adolescents Accessing Antiretroviral Therapy in Selected Health Facilities in Lagos, Nigeria

Abstract

\n IntroductionNigeria has the second largest HIV burden in Sub-Saharan Africa, with high burden amongst children and adolescents. In 2017, it was estimated that 160,000 children (0-9 years) and 230,000 adolescents (10-19 years) are living with HIV globally, with death in 21,000 children and 5400 adolescents resulting from AIDS-related illnesses. The main objective of the study was to determine the factors associated with poor viral suppression in children and adolescents accessing antiretroviral therapy in secondary health facilities in Lagos State.MethodsA descriptive retrospective study of children and adolescents living with HIV accessing care and support in 7 Global Fund supported ART treatment facilities in Lagos between January 2013 and June 2020. Data extraction was done between July 2020 and August 2020. The sociodemographic, clinical and laboratory data were extracted from patients’ folders. Binary logistic regression model was done to identify the determinants of viral non-suppression among children and adolescents age groups. ResultsThe study population consisted of 363 children (age 0-9 years) and 275 adolescents (age 10-19 years). The mean age of children was 5.8±2.2 years and that of adolescent was 13.21±2.8years. About 256(70 %) of children were virally unsuppressed and 118(43 %) had non-suppressed viral load status among adolescents. Binary logistic regression showed that children with WHO stage IV of HIV disease had greater odds (OR=7.984, 95% CI=1.042-61.163) of having suppressed viral load and children who live with their non-biological caregiver had greater odds of having a suppressed viral load compared to the biological caregiver group (OR=2.0421, 95% CI=1.083-10.965). Among adolescents, binary logistic regression showed location of abode and drug pick-up pattern as independent predictors of poor viral suppression. Adolescent patients living in rural setting had greater odds of being virally unsuppressed compared to those living in urban settlement (OR=1.755, 95% CI=1.001-3.083) while patients who have regular drug pick-up pattern from their ART health centres had lesser odds (OR=0.585, 95% CI=0.591-0.912) of viral non-suppression.CONCLUSIONThe findings highlight the need for a renewed focus on developing and strengthening HIV programmes in rural areas where children and adolescents living with HIV are more likely to be virally unsuppressed. More emphasis and resources should be channelled to Public health intervention such as health education, social support group programmes to improve drug pick up and adherence in adolescents living with HIV.