Multilevel factors associated with virological suppression among adolescents and young people with prior non-suppression receiving intensive adherence counselling in East-Central Uganda

Abstract

Background: Adolescents and young people living with HIV continue to experience disproportionately high rates of virological non-suppression despite scale-up of enhanced adherence interventions such as Intensive Adherence Counselling (IAC). While prior research has quantified post-IAC suppression outcomes, there remains limited empirical evidence regarding the multilevel factors that shape virological response in this population. This study investigated multilevel factors associated with viral load suppression among adolescents and young people (AYP) with prior non-suppression who were enrolled in IAC in East-Central Uganda. Methods: A facility-based analytical cross-sectional study was conducted using routinely collected programmatic data from 580 AYP aged 10-24 years with documented unsuppressed viral load who were enrolled in IAC across 32 health facilities. Eligible participants had a repeat viral load measurement following completion of the adherence intervention. Multivariable analysis was performed using modified Poisson regression with robust variance estimation to determine factors independently associated with virological suppression, accounting for clustering at the facility level. Adjusted prevalence ratios (aPRs) with corresponding 95% confidence intervals were reported. Results: The study population had a median age of 16.4 years (interquartile range [IQR]: 12.9-21.2), with females comprising 62.8% of participants. Overall, over half of the cohort achieved virological suppression following the intervention. Engagement in peer-led support was associated with a higher likelihood of suppression (aPR=1.71, 95% CI: 1.36-2.15), as was prior disclosure of HIV status (aPR=1.43, 95% CI: 1.02-2.11). Conversely, participants enrolled in differentiated antiretroviral therapy (ART) delivery models based on community drug distribution prior to IAC had lower suppression compared to those managed through facility-based individualized care (aPR=0.51, 95% CI: 0.35-0.74). Conclusion: Virological outcomes among AYP receiving enhanced adherence support are shaped by a combination of individual and service delivery factors. Interventions that strengthen peer engagement and facilitate safe disclosure, alongside careful alignment of differentiated service delivery models with adherence needs, may improve treatment outcomes in this high-risk population.