Predictors of antiretroviral therapy interruption on community viral load among people living with HIV in Siaya County, Kenya

Background: Community viral load (VL) suppression is essential for assessing HIV treatment effectiveness, uptake, and impact on new HIV infections. Siaya is among the highest HIV burdens County in Kenya, with a prevalence rate of 13.2%, representing 96,297 estimated people living with HIV (PLWHIV). Among retained clients, 90% were virally suppressed, accounting for 51% of estimated PLWHIV. Methods: This cross-sectional, retrospective, and qualitative study was conducted in Gem sub-County of Siaya County, Western Kenya, among re-engaged PLWHIV who interrupted treatment. Data was collected from 13 facilities with highest rates of treatment interruption between January 2017 and December 2022. Participants with shorter appointments were interviewed during clinic visits. Their prospective and retrospective data were merged and analyzed using Chi-square, Fisher’s exact tests, Kaplan–Meier, and Cox proportional hazard models to evaluate associations between demographic, cultural, and socioeconomic characteristics and VL suppression. Results: Of 311 participants assessed, median was age 45 years (IQR: 37–52) and VL suppression rate of 55%. Clients with primary education had lower non-suppression rates than those with university education (HR 0.45; 95% CI, 0.26–0.76), and non-suppression was higher among those in formal employment compared to business (HR 1.95; 95% CI, 1.07–3.53). PLWHIV on ART for over 24 months had lower non-suppression rates (HR 0.5; 95% CI, 0.35–0.73) than those on ART for under 12 months. Conclusions: University education, formal job, or being on ART for less than 12 months increased the risk of attrition. Implementation of client-centred HIV services may improve community VL suppression.