Factors Associated With Viral Load Suppression Among Adolescents and Young Adults Living With HIV on ART in Rwanda: Data From Rwanda HIV Case‐Based Surveillance, 2019–2025

Abstract

Background Adolescents and young adults living with HIV (AYALHIV) in sub‐Saharan Africa have lower viral load (VL) suppression (VLS) rates than older adults. Rwanda lacks national‐level evidence on predictors of VLS in this age group. This study assessed demographic and clinical determinants of VLS among AYALHIV aged 15–24 years on antiretroviral therapy (ART), using national case‐based surveillance (CBS) data. Methods We conducted a retrospective cohort analysis of AYALHIV enrolled in Rwanda’s CBS system who initiated ART between January 2019 and December 2025 and had a documented VL at least six months after ART initiation. The primary outcome, VLS, was defined as VL ≤ 1000 copies/mL. Modified Poisson regression with robust, facility‐clustered standard errors was used to estimate prevalence ratios (PRs); missing covariate data were addressed using multiple imputation (m = 20), pooled using Rubin’s rules. Results A total of 4140 participants across 458 health facilities were included. Most were female (88%) and aged 20–24 years (90.7%); 91.6% were initiated on a dolutegravir‐based regimen, 98.7% demonstrated good adherence, and overall, 96.1% achieved VLS. In multivariable analysis, good adherence was the only factor independently associated with VLS, corresponding to a 70% higher prevalence of suppression relative to bad/moderate adherence (adjusted PR = 1.70; 95% CI: 1.33–2.19; p < 0.001). Conclusion VLS among AYALHIV aged 15–24 years engaged in Rwanda’s HIV care program is high, exceeding the UNAIDS 95% target. Country HIV programs should prioritize adherence‐focused interventions and proactively address underlying barriers to adherence in order to sustain optimal treatment outcomes in this population.