Kenyan HIV Clinics With Youth-Friendly Services and Trained Providers Have a Higher Prevalence of Viral Suppression Among Adolescents and Young Adults: Results From an Observational Study.
Kate Wilson, Alvin Onyango, Cyrus Mugo and 8 others
PMID 34939987WHAT IT FOUND
Among adolescents and young adults in Kenyan HIV clinics with linked viral load results, 76% had viral suppression, but those starting ART as children were less likely to be suppressed than those starting later.
Facilities with both youth-friendly services and trained providers had higher suppression.
Key findings
01Among adolescents and young adults with linked viral load results, 76% (1,581) were virally suppressed at less than 1000 copies/mL at their most recent visit, and 68% (1,415) had undetectable viral load at less than 200 copies/mL.
02Adolescents and young adults who started ART in middle adolescence or young adulthood had a higher probability of viral suppression than those who started in childhood.
03Facilities with both youth-friendly services and providers trained in adolescent HIV care had higher odds of viral suppression than facilities with neither (adjusted OR 2.07, 95% CI 1.71-2.52); neither facility characteristic alone was separately associated.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was cross-sectional and used a non-random sample of facilities, so it can show associations but not cause and effect. Only 39% of adolescents and young adults on ART for at least 6 months had a linked viral load result, so the reported suppression rate may not represent all patients in care. Facilities with youth-friendly services or provider training had more complete viral load data, which may affect the facility comparisons. Youth-friendly services, use of the Adolescent Package of Care checklist, and provider training were self-reported and measured with single questions, which may have introduced error. The study could not assess other influences on viral suppression, such as drug resistance, stigma, or disclosure of HIV status. Patients without viral load data differed in age at ART initiation and diagnosis, so missing data could bias the estimate.
The easy way to misread this
Do not read the facility finding as a tested intervention. The study was cross-sectional and observational, and only the combination of youth-friendly services and trained providers was associated with higher suppression; neither component alone was separately associated.