Predictors of Viral Suppression among People Living with HIV (PLHIV) on Antiretroviral Treatment in Almaty, Kazakhstan

ABSTRACT Introduction The Eastern Europe and Central Asia (EECA) region is experiencing the world’s fastest-growing HIV epidemic, with Kazakhstan among the countries most affected. Despite progress in HIV testing and treatment, Kazakhstan continues to face significant challenges in achieving optimal viral suppression among PLHIV. While 82% of PLHIV in Kazakhstan know their HIV status, only 73% are on ART, and just 67% of those on treatment achieve viral suppression. Adherence to ART remains a critical barrier, influenced by a complex interplay of individual, social, and structural factors, including mental health disorders such as depression, substance use, stigma and discrimination. Understanding the multifaceted determinants of viral suppression is essential for improving treatment outcomes. This study aims to assess the level of viral suppression and identify its predictive factors among PLHIV attending the AIDS center in Almaty, Kazakhstan. Methods Using data from the AIDS Center in Almaty, we performed bivariate analysis to assess the possible factors associated with viral load suppression. Potential predictors included gender, age, marital status, education, region, HIV stage, adherence level, years in care, transmission routes, initiation of HIV treatment before or after implementation of the “Test and Treat” policy, hepatitis C, tuberculosis, alcohol misuse. Then we conducted multivariable logistic regression using backwards elimination to identify the best predictive model. Results Of 3,716 patients aged 18 years and older seen in the Almaty AIDS Center, 72% were virally suppressed. Bivariate analysis showed several factors to be significantly associated with the viral suppression among PLHIV in Almaty. Marital status, education HIV stage, adherence level, years in care, heterosexual and homosexual transmission were statistically significant. Age, gender, region, “Test and Treat” policy, tuberculosis and misuse of alcohol were not shown to be significantly associated with whether or not a person was virally suppressed. Multivariable analysis revealed that five of the factors remained significantly associated with the odds of PLHIV to be virally suppressed. The education level, transmission routes, ART duration, “Test and Treat” policy, and adherence level were all statistically significant in the multivariable analysis. The predictive model showed good performance, with a c-statistic of 0.724, indicating acceptable discriminative ability. Calibration was adequate, as demonstrated by a non-significant Hosmer-Lemeshow test (p = 0.3589). These results suggest the model is both well-calibrated and capable of distinguishing between individuals with and without the outcome. Conclusions This study highlights the multifaceted influence of sociodemographic, behavioral, and clinical factors on viral suppression among PLHIV in Almaty. The findings offer critical insights to inform and enhance HIV care strategies in the city, particularly supporting the ongoing optimization of the "Test and Treat" approach. The findings underscore the need to support ART adherence across all populations, with a heightened focus on people who inject drugs, who face unique barriers to achieving and sustaining viral suppression. Continued research is warranted to elucidate the pathways through which these determinants impact viral suppression and to assess the effectiveness of targeted interventions aimed at improving outcomes for PLHIV in Almaty.