Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study
Abstract Background The goal of antiretroviral therapy (ART) is to achieve a sustained HIV suppressed viral load. However, adolescents often present poor adherence to ART which is associated with lower rates of viral load suppression (VLS). The objective of this study was to determine the viral load...
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BMC
2025-04-01
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| Online Access: | https://doi.org/10.1186/s12879-025-10872-z |
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| author | Londiwe D. Hlophe Constance S. Shumba Diribsa T. Bedada Peter S. Nyasulu |
| author_facet | Londiwe D. Hlophe Constance S. Shumba Diribsa T. Bedada Peter S. Nyasulu |
| author_sort | Londiwe D. Hlophe |
| collection | DOAJ |
| description | Abstract Background The goal of antiretroviral therapy (ART) is to achieve a sustained HIV suppressed viral load. However, adolescents often present poor adherence to ART which is associated with lower rates of viral load suppression (VLS). The objective of this study was to determine the viral load suppression levels and the associated factors among adolescents living with HIV (ALHIV) and on ART in Eswatini. Methods We conducted cross-sectional analysis of data from 911 adolescents aged 10 to 19 living with HIV and on ART between the period January 2017 and September 2022. We collected data of demographic and clinical variables, using a standardized data abstraction tool. We defined viral load suppression as the latest viral load result of ≤ 1000 copies/ml. Univariable and bivariable logistic regression analysis was done to identify factors associated with VLS and factors with p < 0.1 were included in the multivariable regression analysis to adjust for the confounding effect of other variables such as age, sex, and duration of ART. Factors with p < 0.05 were considered statistically significant. Results Among the 911 participants, 60% (457) were female. The mean age of the participants was 16.3 years, with mean duration on ART of 1.8 years. Viral suppression was attained by 88.5% (806/911) of the participants. Residence in the Shiselweni region was an independent factor associated with viral load suppression (aOR 0.37; 95% CI 0.15–0.19; p˂0.027). Conclusion Low VLS is a risk factor for increased viral resistance and perpetuates HIV transmission within the population. Achieving viral suppression among ALHIV in Eswatini is challenging as data shows that VLS is way below the UNAIDS 95% cut off level among individuals on ART. This is particularly more problematic in the Shiselweni region, where viral suppression is lower than the other regions. Therefore, reinforcement of public health interventions is needed to improve treatment support for achieving sustained viral suppression among ALHIV in Eswatini. |
| format | Article |
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| institution | OA Journals |
| issn | 1471-2334 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
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| series | BMC Infectious Diseases |
| spelling | doaj-art-a00f7db6a51a4e4d8568a0a4bbf0f76c2025-08-20T02:16:06ZengBMCBMC Infectious Diseases1471-23342025-04-0125111010.1186/s12879-025-10872-zDeterminants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional studyLondiwe D. Hlophe0Constance S. Shumba1Diribsa T. Bedada2Peter S. Nyasulu3Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDivision of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of WisconsinDivision of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch UniversityDivision of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch UniversityAbstract Background The goal of antiretroviral therapy (ART) is to achieve a sustained HIV suppressed viral load. However, adolescents often present poor adherence to ART which is associated with lower rates of viral load suppression (VLS). The objective of this study was to determine the viral load suppression levels and the associated factors among adolescents living with HIV (ALHIV) and on ART in Eswatini. Methods We conducted cross-sectional analysis of data from 911 adolescents aged 10 to 19 living with HIV and on ART between the period January 2017 and September 2022. We collected data of demographic and clinical variables, using a standardized data abstraction tool. We defined viral load suppression as the latest viral load result of ≤ 1000 copies/ml. Univariable and bivariable logistic regression analysis was done to identify factors associated with VLS and factors with p < 0.1 were included in the multivariable regression analysis to adjust for the confounding effect of other variables such as age, sex, and duration of ART. Factors with p < 0.05 were considered statistically significant. Results Among the 911 participants, 60% (457) were female. The mean age of the participants was 16.3 years, with mean duration on ART of 1.8 years. Viral suppression was attained by 88.5% (806/911) of the participants. Residence in the Shiselweni region was an independent factor associated with viral load suppression (aOR 0.37; 95% CI 0.15–0.19; p˂0.027). Conclusion Low VLS is a risk factor for increased viral resistance and perpetuates HIV transmission within the population. Achieving viral suppression among ALHIV in Eswatini is challenging as data shows that VLS is way below the UNAIDS 95% cut off level among individuals on ART. This is particularly more problematic in the Shiselweni region, where viral suppression is lower than the other regions. Therefore, reinforcement of public health interventions is needed to improve treatment support for achieving sustained viral suppression among ALHIV in Eswatini.https://doi.org/10.1186/s12879-025-10872-zHIVViral load suppressionAdolescents living with HIVKingdom of eswatiniAntiretroviral therapy |
| spellingShingle | Londiwe D. Hlophe Constance S. Shumba Diribsa T. Bedada Peter S. Nyasulu Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study BMC Infectious Diseases HIV Viral load suppression Adolescents living with HIV Kingdom of eswatini Antiretroviral therapy |
| title | Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study |
| title_full | Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study |
| title_fullStr | Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study |
| title_full_unstemmed | Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study |
| title_short | Determinants of viral load suppression among adolescents on antiretroviral therapy in Eswatini: a cross-sectional study |
| title_sort | determinants of viral load suppression among adolescents on antiretroviral therapy in eswatini a cross sectional study |
| topic | HIV Viral load suppression Adolescents living with HIV Kingdom of eswatini Antiretroviral therapy |
| url | https://doi.org/10.1186/s12879-025-10872-z |
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