Adolescent HIV in Tanzania: Factors Affecting Viral Load Suppression and the Transition to Adult Care

To meet the 95-95-95 targets, Tanzania needs to accelerate strategies to address the needs of this population. The country is in the process of scaling up routine viral load testing, and increasing numbers of adolescents living with HIV are "aging out" of pediatric care and requiring transition to adult care. The study explored factors affecting viral load testing, viral suppression, and the transition from adolescent to adult care. Quantitative analysis of viral load testing and viral suppression was conducted using secondary analysis of care, treatment, and viral load data from Tanzania's health facility-based electronic medical records system, CTC2. The study population consisted of children, adolescents, and young adults (ages 0-24) living with HIV who initiated antiretroviral therapy (ART) at or before 19 years of age and received services at facilities supported by Management and Development for Health (MDH) in the Dar es Salaam region. The objectives of the quantitative analysis were to establish baseline estimates and trends for viral load testing and viral suppression, and to identify potential causes of variance in viral load testing and viral suppression. Research questions focused on the proportion of children, adolescents, and young adults living with HIV who received at least one viral load test, the proportion who were virally suppressed, and demographic and clinical characteristics associated with viral load testing and viral suppression. The study found that the proportion of children, adolescents, and young adults living with HIV who received at least one viral load test was relatively low, with only 44.6% of the study population having received a viral load test. Viral suppression was also low, with only 24.1% of the study population having a viral load below 1,000 copies/ml. Demographic and clinical characteristics associated with viral load testing and viral suppression included age, sex, and ART adherence. The study also conducted qualitative analysis of viral suppression and the transition to adult care, which identified barriers and enablers affecting viral load testing, viral suppression, and successful transition to adult care among adolescents living with HIV. The qualitative analysis found that barriers to viral load testing and viral suppression included lack of access to testing facilities, inadequate ART adherence, and stigma and discrimination. Enablers included strong support from family and caregivers, access to education and employment opportunities, and effective communication with healthcare providers. The study estimated the number of people eligible for and actually transitioning to adult HIV care each year from 2018 to 2025 using the HP+ Pediatric HIV Transition Model. The results of the study will contribute to global evidence and dialogue on pediatric HIV care, and will inform strategies to support adolescents and youth living with HIV in Tanzania. The study's findings highlight the need for accelerated strategies to address the needs of this population, including increased access to viral load testing, improved ART adherence, and effective transition to adult care.