Virological failure among adolescents on ART, Harare City, 2017- a case-control study

Zvanaka Sithole, Elizabeth Mbizvo, Prosper Chonzi, More Mungati, Tsitsi Patience Juru, Gerald Shambira, Notion Tafara Gombe, Mufuta Tshimanga, Zvanaka Sithole, Elizabeth Mbizvo, Prosper Chonzi, More Mungati, Tsitsi Patience Juru, Gerald Shambira, Notion Tafara Gombe, Mufuta Tshimanga

Abstract

Background: Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10-19 years) on antiretroviral therapy (ART) in Harare city.

Methods: We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL < 1000c/ml after at least 12 months on ART. Interviewer administered questionnaires were used to collect data. Epi Info 7 was used to generate frequencies, means, proportions, ORs and p-values at 95% CI.

Results: We interviewed 102 case-control pairs. Poor adherence to ART [aOR = 8.15, 95% CI (2.80-11.70)], taking alcohol [aOR = 8.46, 95% CI (3.22-22.22)] and non- disclosure of HIV status [aOR = 4.56, 95% CI (2.20-9.46)] were independent risk factors for virological failure. Always using a condom [aOR = 0.04, 95% CI (0.01-0.35)], being on second line treatment [aOR = 0.04, 95% CI (0.23-0.81)] and belonging to a support group [aOR = 0.41, 95% CI (0.21-0.80)] were protective.

Conclusion: Poor adherence, alcohol consumption and non-disclosure increased the odds of virological failure. Based on these findings support should focus on behavior change and strengthening of peer to peer projects to help address issues related to disclosure and adherence. Further operational research should aim to define other components of effective adherence support for adolescents with virological failure.

Keywords: Adolescents; Case control; Harare city; Viral load suppression.

Conflict of interest statement

Ethics approval and consent to participate

Strict confidentiality was assured and ensured at all times when handling data during all processes of data collection, capturing, analysis and storage. Permission to conduct the study was obtained from the Harare city ethical review board, Joint Research Ethical Committee (Ref: JREC/164/16), and Medical Research Council of Zimbabwe (Ref: MRCZ/ B/1314). Written informed consent was sought and obtained from study participants who were 18 years and above. For participants aged below 18 years assent was obtained and written informed consent was obtained from their parents or guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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