Correlates of virological non-suppression among children and adolescents aged 5-19 years on Dolutegravir-based regimens attending Gulu regional referral hospital, Northern Uganda: a mixed methods cross-sectional study.

BACKGROUND

Viral suppression has been sub-optimal among children and adolescent in Uganda, despite a near-universal transition to the much effective Dolutegravir-based regimens. Therefore this study was aimed at determining the prevalence of virological non-suppression and its associated correlates among children and adolescents aged 5-19 years on Dolutegravir-based regimens.

METHODS

A mixed methods cross-sectional study was conducted among 303 children and adolescents aged 5-19 years on Dolutegravir-based regimens from January 2021 to December 2022. The chi-square likelihood ratio test and Modified Poisson regression analyses were used to identify correlates significantly associated with virological non-suppression. Purposive and convenient sampling were done and interviews analyzed using manual thematic content analysis.

RESULTS

Virological non-suppression prevalence was at 12.2% (95% CI: 8.5% - 16.0%). Parental status (being single orphan, adjusted Prevalence Ratio (aPR: 5.4 [95% CI: 1.81-15.90], p = < 0.001), (double orphan, aPR: 3.3 [95% CI: 1.07-10.02], p = 0.04), clinical stage (WHO clinical stage II on Dolutegravir-based anti-retroviral therapy initiation (aPR: 3.4 [95% CI: 1.55-7.62], p = < 0.001), and malnutrition status (moderate acute malnutrition (aPR: 2.3 [95% CI: 1.16-4.76], p = 0.02) were significantly associated with virological non-suppression. Findings also indicated that differentiated service delivery models, multi-month drug dispensing tolerability and palatability of Dolutegravir, adolescent child friendly services, awareness and stigma reduction programs, having a caregiver and having a caregiver who is on anti-retroviral therapy emerged as important deterrents to virological non-suppression. However, HIV status non-disclosure, food unavailability, deprivation of family and social support, secondary school age, poor adherence, malnutrition, depression, tuberculosis co-infection, disease progression to stage II and above, drug holidays and fatigue, transitioning from child to adolescent age and information gap on treatment were potential enablers of virological non-suppression.

CONCLUSION

The prevalence of virological non-suppression among children and adolescents aged 5-19 years on Dolutegravir-based regimens was 12.2%. This was relatively lower in comparison to other studies conducted in Uganda and other Sub-Saharan African countries but short of the UNAIDS third 95% target for viral suppression.