Viral suppression among adolescents and young adults on ART before and after structured transition to adult care in rural Western Kenya

BACKGROUND: Kenya 2018 national HIV treatment guidelines recommend structured transition of adolescents (10'19 years) living with HIV (ALHIV) to adult care. In 2018, viral suppression among ALHIV was 61.4% compared to 71.6% among adults'a continued gap among transitioned ALHIV. We evaluated viral suppression (VS) before and after transition to adult care among ALHIV following implementation of adolescent package of care (APOC) and transition guidelines.
METHODS: This retrospective cohort analysis included young people living with HIV (YPLHIV) aged 19-24 years who transitioned to adult care. The sample included people active on ART in October 2018 in 37 facilities in Kisii and Migori counties Viral load results recorded before and after age 19 years were defined as pre- and post- transition respectively. Routinely collected demographic and clinical data were abstracted from electronic medical records. Proportion of VS [viral load (VL) <1000c/ml] among AYHIV with paired VL data was calculated before and after transition and compared using chi square tests. Multivariable alternate logistic regression was used to assess factors associated with VL suppression including age, gender and duration on ART in the pre- and post-transition periods.
RESULTS: Paired VL data from a total of 527 individuals were analyzed. The median age was 21 years [interquartile range (IQR): 20'22] and median duration on ART was 7 years [IQR:4.3'9.1]. Overall, there was a statistically significant difference in viral suppression before and after transition [76.3% (n=402) vs. 81.4% (n=429) p <.0001]. Those on ART > 7 years were more likely to have VS before and after transition compared to those on ART for < 7 years, [OR=2.06; 95% confidence interval (CI) 1.58-2.55] and [OR=1.97; 95%CI 1.44- 2.50]. Young women were more likely to be suppressed before and after transitioning [OR=2.10; 95%CI 1.64-2.56] and [OR=2.10; 95%CI 1.54- 2.63] respectively.
CONCLUSIONS: These findings demonstrate better VS rates after ALHIV transition to adult HIV care. Although implementation of the APOC and transition guidelines may enhance VS among YPLHIV, additional strategies are needed after transitioning for young men and patients on ART < 7 years.