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Impact of enhanced adherence counselling on viral re-suppression among adolescents and young persons with persistent high viremia in selected health facilities in Kisii and Migori county, Western Kenya

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BACKGROUND: Globally, adolescents and young persons (AYP; 10-24yrs) on antiretroviral therapy (ART) experience suboptimal ART adherence and viral suppression (VS). In 2017, VS among adolescents (10-19yrs) was 61.4% compared to adults at 71.6% in Kenya. Kenya ART guidelines recommend 3 sessions of Enhanced Adherence Counselling (EAC) following detectable Viral Load (VL). We assessed completion of EAC and factors associated with viral re-suppression amongst AYPs with persistent viremia in western Kenya.
METHODS: This was a retrospective analysis of routinely collected data abstracted from electronic medical records in 20 high volume facilities supported by University of Maryland, Baltimore. AYP with persistent viremia (>1,000 copies/ul) between October 2017 to September 2019 were followed for 12 months; those with '§ one follow-up VL test were included in the analysis. Persistent viremia referred to non-VS of > 1 consecutive VL tests. EAC sessions were 'satisfactory' if '§3 sessions were conducted and barriers successfully identified or 'unsatisfactory' if otherwise. Medication adherence (MA) was assessed using the standard Morisky MA score ('¥1 considered sub-optimal, 0 considered optimal adherence). Bivariate logistic regression model was used to assess predictors of VS at 95% confidence interval (CI).
RESULTS: Of 124 AYPs with persistent viremia, 118 (95.2%) had a documented follow up VL and were included in the analysis. The median age was 15.9 years (interquartile range14.0 ' 18.0) and 52.5% (62) were male. Overall, 39.8% (47) of patients re-suppressed during the study period. In total 54.2% (64) had satisfactory EAC sessions and 50.8% (60) had optimal adherence. AYPs who had satisfactory EAC sessions were four times more likely to have VS (odds ratio [OR] 3.92, 95% confidence interval [CI]: 1.70 ' 8.99). AYPs with an optimal adherence score were six times (OR 6.4, 95% CI: 2.8-14.8) more likely to have VS, and those who were suppressed at 6 months post ART initiation were three times (OR 2.7, 95% CI:1.1.-6.8) more likely to have VS.
CONCLUSIONS: Completion of the recommended 3 EAC sessions with optimal ART adherence were strongly associated with viral re-suppression among AYPs with persistent viremia. Strategies to improve EAC completion with ART adherence could improve viral re-suppression and outcomes among AYP living with HIV.