Determinants of viral suppression among young people living with HIV and on antiretroviral therapy in Eswatini: A cross-sectional study

<i>Background</i>: HIV treatment, adherence, and retention in care are fundamental in achieving viral load suppression (VLS) and fighting the HIV pandemic. The Government of Eswatini has decentralised antiretroviral treatment (ART) services and introduced differentiated HIV service delivery models to improve treatment outcomes for all people living with HIV, including young people. It is imperative to investigate the success of these initiatives in improving VLS in young people living with HIV (YPLHIV) in Eswatini.<i>Objective</i>: To determine the factors associated with VLS amongst YPLHIV (15 to 24 years) who are on ART in Eswatini.<i>Methodology</i>: A retrospective cohort analysis of 4 334 YPLHIV on ART in Eswatini between January 2018 and December 2021 was conducted. The Statistical Package for Social Scientists version 25 was used to determine the factors associated with viral suppression through bivariate and logistic regression analysis.<i>Results</i>: The prevalence of viral suppression (< 1 000 copies/mL) was 92.9%. After adjusting for all covariates, the likelihood of viral suppression remained significantly higher among YPLHIV who were female (AOR = 2.06; CI 1.04-4.11), had enrolled on the fast-track ART care model (AOR = 2.14; CI 1.09-4.20), and were receiving 4 to 5 months' (AOR = 5.88; CI 3.14-11.02) and 6+ months' (AOR = 3.55; CI 1.67-7.53) of medication.<i>Conclusion</i>: The national HIV treatment program in Eswatini exceeded the UNAIDS target of 90% virologic suppression for YPLHIV who are enrolled for ART for more than six months. However, to meet the revised 95% target, tailored interventions are required to strengthen long-term adherence and retention in care for YPLHIV on ART.