Longitudinal challenges faced by perinatally-infected young people living with HIV in Kenya during the COVID-19 pandemic

BACKGROUND: Understanding challenges experienced by adolescents and youth living with HIV (AYLWH) during COVID-19 can inform care during health crises. METHODS: From 2021-2023, bi-monthly in-person/phone surveys were administered to assess trends in psychological, physical, and socioeconomic challenges, and antiretroviral nonadherence, among Kenyan AYLWH, alongside COVID-19 burden (casesloads and Oxford-Stringency-Index (OSI)). Biannual viral loads (VLs) were described as virologic suppression (VL < =40copies/mL), virologic failure (VL>40copies/mL), and treatment failure (VL>1,000copies/mL). Associations among caseloads/OSI, challenges, nonadherence, and treatment failure transitions (VL < =1,000 to >1,000copies/mL and vice versa) were evaluated using regression models, accounting for repeated-measures, age, gender, clinic, and between-visit days. RESULTS: Among 441 participants (mean age 16.9 years, 49% female, mean time on ART 11.9 years), 89% reported at enrollment challenges (48% psychological, 66% physical, 61% socioeconomic). Within-subject challenges, COVID-19 caseloads, and OSI scores varied over time alongside pandemic changes. During stringent periods and surges, physical challenges worsened (OR = 1.04 per 100-cases increase/day, CI = 1.00-1.08); psychological challenges were stable (OR = 1.02, CI = 0.98-1.06); socioeconomic challenges worsened during caseloads upticks (OR = 2.08, CI = 1.14-3.81). Higher challenges burden at enrollment was associated with slower reduction in challenges over time. Nonadherence (74% at enrollment) was associated with higher prior-visit challenges (Psychological: OR = 1.37, CI = 1.24-1.51; Physical: OR = 1.43, CI = 1.22-1.69; Socioeconomic: OR = 1.27, CI = 1.11-1.46). Virologic and treatment failure occurred in 19% and 10%; suppression-to-failure transition was associated with worsening adherence (OR = 1.26, CI = 1.00-1.58). CONCLUSIONS: Kenyan AYLWH experienced substantial wellness challenges during COVID-19, possibly prompting poor adherence and viral outcomes. While stability of non-physical challenges suggests COVID-19 adaptation, targeted interventions are warranted to support this vulnerable population during public health crises.