Factors associated with viral suppression and antiretroviral therapy adherence among adolescents and young adults living with HIV in the African Cohort Study.
INTRODUCTION Adolescents and young adults living with HIV (AYLHIV) experience poor outcomes across the care continuum, and most reside in sub-Saharan Africa. The African Cohort Study (AFRICOS) provides an opportunity to examine HIV outcomes in this population across Kenya, Nigeria, Tanzania, and Uganda. METHODS We conducted a cross-sectional analysis of AYLHIV aged 15-29 years, enrolled in AFRICOS 2013-2023, and on antiretroviral therapy (ART) ≥ six months. Primary outcomes were HIV viremia and 30-day ART non-adherence. Factors included HIV acquisition route, ART duration, ART class, and site. We used multivariate robust Poisson regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Site directors were surveyed to assess youth-friendly services. RESULTS Among 656 participants, the median age was 20.0 years (IQR 17.5-23.3); 41.6% were male, 61.6% had perinatally-acquired HIV, and median duration since HIV diagnosis was nine years. At enrollment, 83.8% had viral suppression (<200 copies/mL) and 80.2% were ART adherent. ART regimen and clinic site were associated with viral suppression: youth on integrase vs. protease inhibitor-based regimens (adjusted relative risk (aRR) 0.38, CI 0.23-0.63, p<0.001), and in Uganda (aRR 0.42, CI 0.20-0.90, p=0.026) or Kisumu, Kenya (aRR 0.40, CI 0.22-0.76, p=0.005) had lower likelihood of non-suppression. Compared to Nigeria, participants from other sites were less likely to report non-adherence (unadjusted RR 0.31-0.44). Youth-friendly service provision varied. CONCLUSIONS Viral suppression and ART adherence were high among AYLHIV in AFRICOS. Clinic site and ART regimen were associated with outcomes, highlighting the importance of health system factors.