Predictors of time to viral load suppression in young people in Gwanda District, Zimbabwe, 2021

Introduction: Antiretroviral Treatment (ART) aims to achieve and maintain viral suppression in HIV patients. Unsuppressed viral load leads to HIV transmission, susceptibility to infections, and premature death. Gwanda District failed to meet the 90% national viral load suppression target. Predictors of time to viral load suppression in ART-initiated young people were determined to generate information to improve the provision of HIV treatment in Gwanda District. Methods: Complete records of young people initiated on ART in Gwanda District were reviewed. Data was captured using Microsoft Excel and analyzed using Epi info 7. Kaplan Meier log-rank test was used to compare time to event experience between groups and cox proportional hazard model to determine significant predictors. Results: Median time to suppression was 207 days and (interquartile range [IQR] 204-215). Most were females 502/667 (75.4%) and majority age group was 21-25 years (64.3%). Categories of Cotrimoxazole preventative therapy (CPT), baseline CD4, baseline viral load, and Tuberculosis Preventative therapy (TPT) showed significant curves differences (P-value<0.00). Independent predictors of time to suppression included baseline CD4 count [Adjusted Hazard Ratio (AHR) =2.52, 95% CI: 1.94-3.28], CPT (AHR=3.18, 95% CI: 2.31-4.38), TPT (AHR=5.48, 95% CI: 4.22-7.11), substance use (AHR=1.56, 95% CI: 1.14-2.14), and migration (AHR=1.549, 95% CI: 1.25-1.92). Conclusion: Predictors of time to suppression were baseline CD4, baseline viral load, migration and substance use probably due to defaulting by substance users and reduced ART access among migrants. Preventative therapy initiation reduced time to suppression. We recommended intensified follow-up, improved access to HIV services among migrants and facilitation of HIV continuum of care cross border coordination.