MOPEC326
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Title
Vertically-infected adolescents have poor viral suppression compared to horizontally-infected youth
Presenter
Kate Wilson
Authors
K. Wilson1, A. Onyango2, C. Mugo3, B. Guthrie4, J. Slyker1, B. Richardson5, G. John-Stewart6, I. Inwani7, D. Bukusi8, D. Wamalwa9, P. Kohler10
Institutions
1University of Washington, Global Health, Seattle, United States, 2University of Nairobi/ University of Washinton, Nairobi, Kenya, 3University of Washington, Seattle, United States, 4University of Washington, Global Health, Epidemiology, Seattle, United States, 5University of Washington, Biostatistics, Global Health, Seattle, United States, 6University of Washington, Global Health, Epidemiology, Pediatrics, Medicine, Seattle, United States, 7Kenyatta National Hospital, Pediatrics, Nairobi, Kenya, 8Kenyatta National Hospital, Voluntary Counseling and Testing, Nairobi, Kenya, 9University of Nairobi/ University of Washinton, Pediatrics, Nairobi, Kenya, 10University of Washington, Psychosocial and Community Health, Global Health, Seattle, United States

Background: Sustained viral suppression in adolescents and young adults (AYA) is necessary to optimize benefits of antiretroviral therapy (ART). Kenya is among the first African countries to launch routine viral load (VL) testing. Using program data, we examined correlates of viral suppression among AYA in HIV care.
Methods: We abstracted electronic medical record and VL data from AYA ages 10-24 at 24 HIV clinics in Kenya from a 15-month period. VLs retrieved from a national database were linked with individual-level data. Viral suppression was defined as last VL< 1000 copies/ml (c/ml) among AYA on ART ≥6 months. Vertical infection was defined as age at HIV diagnosis < 15 years. Log-binomial regression estimated adjusted risk ratios (aRRs) and 95% Confidence Intervals (CIs) between correlates and VL suppression at last measure, accounting for clustering by facility. Correlates of sustained VL suppression, defined as any two consecutive results < 1000 c/ml, were compared to AYA with suspected virologic failure, or two consecutive results ≥1000 c/ml.
Results: Of 4,335 AYA on ART ≥6 months, 2,085 (48.1%) had VL results; 30.1% were ages 10-14, 23.6% 15-19, and 46.3% 20-24 at first VL. Most were female (70.3%), had vertically acquired HIV (59.7%), initiated ART before age 10 (33.7%) or at ages 20-24 (30.3%), and were on 1st-line regimens (96.4%). Overall, 76.0% were virally suppressed. In multivariable models adjusted for gender, age, time on ART, and pregnancy, horizontally acquired HIV was associated with higher prevalence of viral suppression compared to vertical acquisition (aRR 1.36, 95%CI: 1.20-1.54). Older age at ART initiation was associated with higher prevalence of VL suppression vs. initiation at < 10 years (20-24 aRR 1.16, 95%CI:1.03-1.31; 15-19 aRR 1.11, 95%CI:1.00-1.23). Among 525 AYA with 2+ VLs, 63.8% had sustained suppression, 14.9% had 1 suppression, while 21.3% had suspected VL failure. In adjusted regression models, horizontal acquisition remained associated with sustained VL suppression (aRR 1.77, 95% CI 1.17-2.67).
Conclusions: Nearly 25% of AYA had unsuppressed VL in this programmatic analysis. Vertically infected adolescents had the lowest likelihood of sustained VL suppression. Targeted treatment approaches and improved VL monitoring are critical to achieve 95 percent viral suppression among AYA.

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