Viral load non-suppression among adolescents and youth living with HIV in South Africa

Despite the increased initiation and uptake of antiretroviral therapy (ART) in South Africa, some people living with HIV (PLHIV) who are on ART still have nonsuppressed viral load (VL). This study aimed to determine the prevalence of VL non-suppression among adolescents and youth (aged 12 years – 24 years) living with HIV and on ART in South Africa, as well as the factors associated with it. Data from the 2017 South African national HIV prevalence, incidence, behaviour, and communication survey were analysed. The survey used a multistage-stratified cluster sampling design. A backward stepwise multivariable generalised linear model was used to identify factors associated with VL non-suppression. The study included 340 participants aged 12 years – 24 years, with a median age of 21 (interquartile range [IQR]: 18–23). The proportion of adolescents and youth living with HIV and on ART with non-suppressed VL was 19.2% (95% confidence interval [CI]: 14.4–25.3). Approximately 60% of the participants were not on ART. The odds of VL non-suppression were significantly higher among youth aged 15 years – 19 years (adjusted odds ratio [AOR] = 1.63 [95% CI: 1.24–2.13], p = 0.001) and aged 20 years – 24 years (AOR = 1.22 [95% CI: 1.06–1.41], p = 0.005) compared to adolescents aged 12 years – 14 years. The odds were significantly lower among individuals of other races (AOR = 0.80 [95% CI: 0.69–0.92], p = 0.003) compared to black African people. Findings suggest a need for ART education and counselling as part of treatment support. In addition, the promotion of HIV awareness as part of strengthening the HIV treatment and prevention cascade.