Hiv Viral Non-suppression Trends in Siaya County: 2015-2021

Abstract

Background: Siaya County in Kenya remains among the top five counties with the leading burden of HIV/AIDS. Understanding trends and predictors of unsuppressed viral load can help manage transmission and reduce associated burdens. Methodology: Data from Kenya's national viral load database (2015–2021) in Siaya County was retrospectively analyzed. A total of 444,389 tests were analyzed to evaluate the trends in viral non-suppression using the Mann-Kendall trend test. Univariate and multivariate logistic regression models were employed to identify the predictors of viral non-suppression and the prediction model was validated using the K-fold cross-validation technique. Results: The number of viral load tests increased each year, from 7,618 in 2015 to 30,178 in 2021. The highest proportion of viral non-suppression was observed in 2017 (21%). Non-suppression decreased from 19% in 2015 to 5% in 2021. Most tested patients were female (296,866; 67%), and the most common sample type was fresh plasma (324,502; 73%) with most of the samples being for routine viral load tests (396,650; 90%). Viral non-suppression decreased from 19% in 2015 to 5% in 2021, with a significant negative trend (tau = -081, p-value = 0.016; Sen's slope = -2.6, p-value = 0.016). Males had a higher likelihood of non-suppression. Viral non-suppression in children, adolescents, and adults significantly declined over time, while among infants it increased but the trend was not statistically significant (tau = 0.23, p-value = 0.548; Sen's slope = 3.03, p-value = 0.548). Recency testing was strongly associated with increased odds of non-suppressed VLs (aOR = 20.00, 95% CI: 7.88–51.45, p < 0.001) while breastfeeding mothers and pregnant mothers had no significant associations with non-suppressed viral loads. The 2 NRTI + 1 NNRTI regimen combination increased the odds of viral non-suppression (aOR = 1.26, 95% CI: 1.15–1.39, p < 0.001). Conclusion: While viral non-suppression rates decreased over time, they remained below the Joint United Nations Programme on HIV/AIDS targets specifically in infants and children. Concerns arise regarding increasing non-suppression among infant patients. The choice of antiretroviral regimen was strongly associated with non-suppression. Further investigation is needed to understand resistance patterns and their impact on treatment response, especially with different regimen combinations.