Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study
Abstract Background Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adol...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-01-01
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| Series: | Tropical Medicine and Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41182-019-0135-z |
| _version_ | 1819032966683164672 |
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| author | Julian Natukunda Peter Kirabira Ken Ing Cherng Ong Akira Shibanuma Masamine Jimba |
| author_facet | Julian Natukunda Peter Kirabira Ken Ing Cherng Ong Akira Shibanuma Masamine Jimba |
| author_sort | Julian Natukunda |
| collection | DOAJ |
| description | Abstract Background Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10–19 years) receiving antiretroviral therapy (ART) in Uganda. Methods We conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients’ demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression. Results We analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96). Conclusion More than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations. |
| first_indexed | 2024-12-21T07:10:21Z |
| format | Article |
| id | doaj.art-8a3764e3c3f046f2a0674e9f9374e211 |
| institution | Directory Open Access Journal |
| issn | 1349-4147 |
| language | English |
| last_indexed | 2024-12-21T07:10:21Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Tropical Medicine and Health |
| spelling | doaj.art-8a3764e3c3f046f2a0674e9f9374e2112022-12-21T19:12:00ZengBMCTropical Medicine and Health1349-41472019-01-0147111010.1186/s41182-019-0135-zVirologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional studyJulian Natukunda0Peter Kirabira1Ken Ing Cherng Ong2Akira Shibanuma3Masamine Jimba4Public Health and Management, Institute of Health, International Health Sciences UniversityPublic Health and Management, Institute of Health, International Health Sciences UniversityDepartment of Community and Global Health, Graduate School of Medicine, The University of TokyoDepartment of Community and Global Health, Graduate School of Medicine, The University of TokyoDepartment of Community and Global Health, Graduate School of Medicine, The University of TokyoAbstract Background Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10–19 years) receiving antiretroviral therapy (ART) in Uganda. Methods We conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients’ demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression. Results We analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96). Conclusion More than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations.http://link.springer.com/article/10.1186/s41182-019-0135-zHuman immunodeficiency virus (HIV)AdherenceAdolescentsViral suppressionVirologic failureAntiretroviral therapy |
| spellingShingle | Julian Natukunda Peter Kirabira Ken Ing Cherng Ong Akira Shibanuma Masamine Jimba Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study Tropical Medicine and Health Human immunodeficiency virus (HIV) Adherence Adolescents Viral suppression Virologic failure Antiretroviral therapy |
| title | Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study |
| title_full | Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study |
| title_fullStr | Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study |
| title_full_unstemmed | Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study |
| title_short | Virologic failure in HIV-positive adolescents with perfect adherence in Uganda: a cross-sectional study |
| title_sort | virologic failure in hiv positive adolescents with perfect adherence in uganda a cross sectional study |
| topic | Human immunodeficiency virus (HIV) Adherence Adolescents Viral suppression Virologic failure Antiretroviral therapy |
| url | http://link.springer.com/article/10.1186/s41182-019-0135-z |
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