Predictors of viral non-suppression among key populations in Lagos, Nigeria: a retrospective matched case-control study.

Despite advances in antiretroviral therapy, viral suppression rates remain suboptimal among key populations in Lagos, Nigeria. This study investigated sociodemographic and clinical predictors of viral non-suppression in these high-risk groups. A retrospective matched case-control study was conducted using clinical records and structured adherence interviews of 520 ART-experienced participants (260 virally unsuppressed cases matched 1:1 with 260 suppressed controls) across six clinics in Lagos. Bivariate analyses and multivariable conditional logistic regression identified predictors of non-suppression, adjusting for matching factors. Baseline predictors, CD4 <200 cells/μL: adjusted odds ratio [aOR] = 4.12 (95% CI: 2.87-5.91; p < 0.001) and viral load >1000 copies/mL: aOR = 6.85 (95% CI: 4.23-11.09; p = 0.001), were strongly associated with non-suppression. TB coinfection independently predicted non-suppression (aOR = 2.34, 95% CI: 1.15-4.76; p = 0.015). Adherence barriers varied across subgroups but were not independently associated with suppression status after adjustment. Programs should prioritize earlier HIV diagnosis and rapid connection to care for patients presenting with low CD4 or high viral load, integrate TB/HIV services, and provide targeted adherence support, particularly for males with TB coinfection.List of Abbreviations: AIDS: Acquired Immunodeficiency Syndrome; aOR: Adjusted Odds Ratio; ART: Antiretroviral Therapy; AUC: Area Under the Curve; CHUM: Socioeconomic barriers; CI: Confidence Interval; CRB: Clinic-Related Barriers; EAC: Enhanced Adherence Counselling; FSW: Female Sex Workers;HBV: Hepatitis B Virus; HCV: Hepatitis C Virus; HIV: Human Immunodeficiency Virus; IPV: Intimate Partner Violence; IQR: Interquartile Range; LGA: Local Government Area; LSACA: Lagos State AIDS Control Agency; MSM: Men Who Have Sex with Men; NAIIS: Nigeria HIV/AIDS Indicator and Impact Survey; NGO: Non-Governmental Organisation; PHE: Psychological Distress; PWID: People Who Inject Drugs; STI: Sexually Transmitted Infection; TB: Tuberculosis; UNAIDS: Joint United Nations Program on HIV/AIDS; VL: Viral Load; WHO: World Health Organization.