Barriers to viral load suppression among HIV-positive adolescents in antiretroviral therapy: a retrospective cohort study in Tanga, Tanzania

Abstract Background: Despite lower rates of the human immunodeficiency virus (HIV) among adolescents in Tanzania, the number of adolescents living with HIV is increasing. Generally, adolescents are lagging in achieving the “Third 95” target that focuses on suppressing the viral load to 95% of those on treatment. This study aimed to describe factors independently associated with viral load non-suppression among HIV-positive ART-experienced adolescents in care and treatment health services facilities supported by Amref Health Africa Tanzania in the Tanga region. Methods: A retrospective review of routinely collected HIV program records was carried out. We extracted data from the CTC2 database that included age, sex, BMI, WHO HIV staging, marital status, ART duration, VLS, regimen, facility level, and Dolutegravir (DTG)-based drug. Descriptive analysis using frequencies was carried out to describe the study participants' sociodemographic and clinical characteristics. Multiple logistic regression was done to adjust for factors associated with viral load non-suppression. Viral load non-suppression was defined as viral load ≥ 1000 copies/ml. Results: 2493 (98%) adolescents were on first-line ART, and 2286 (89.68%) participants were virally suppressed, while 263 (10.32%) had viral load non-suppression (≥ 1000 copies/ml). In addition, 2322 (91.09%) of participants on ART were using DTD-related drugs; of them, 92.76% were virally suppressed. Not using DTG-related drugs (OR: 13.89, 95% CI 6.44 – 16.96) and hospital facility level (OR: 3.53, 95% CI 1.39 – 8.99) were independently associated with increased odds for not achieving viral load suppression. In addition, adolescents aged between 15 – 19 years were more likely associated with viral load suppression (OR: 0.54, 95% CI 0.30 – 0.97). Conclusion: 10.32% of the adolescents on ART did not achieve viral load suppression, not using DTG-related drugs, and the hospital facility level increased the odds of not achieving viral load suppression. The use of DTG-related drugs significantly lowered viral load. HIV intervention strategies should be improved to ensure DTG utilisation in all PLHIV on ART and techniques used by health centres are disseminated to the hospital facility level.