"Swallowing these drugs every day, you get tired": a mixed-methods study to identify barriers and facilitators to retention and HIV viral load suppression among the adolescents living with HIV in TASO Mbale and TASO Soroti centers of excellence

Background Adolescents aged 10-19 years, living with HIV (ALHIV) lag in attaining optimal viral load suppression (VLS) rates and retention in care. This study aimed to identify barriers and facilitators to both treatment outcomes in TASO Mbale and TASO Soroti centers of excellence. Methods We used a mixed methods approach, extracting secondary data on ALHIV who were active in care during April-June 2022 quarter to determine one year retention and VLS (HIV RNA copies < 1000/ml). Analysis was done in STATA Corp, 15.0. We used logistic regression to determine predictors and adjusted odds ratio (aOR) to report levels of predictability, using 95% confidence interval (CI) and P < 0.05 for statistical significance. For qualitative component, purposive sampling of 59 respondents was done. Focused group discussions, key informant interviews, and in-depth interviews were used to collect data. Thematic content analysis was done using Atlas ti. Results There were 533 ALHIV, median age of 15 years, interquartile range of 11-18 and 54.2% females. 12-month retention rate was 95.9% and VLS of 84.0%. Poor and fair adherence [aOR = 0.044, 95% CI 0.010-0.196, P < 0.001)], [aOR = 0.010, 95% CI (0.002-0.039) P < 0.001] respectively had decreased odds for VLS while multi-month dispensing of drugs (aOR = 3.403, 95% CI 1.449-7.991, P = 0.005) had increased odds of VLS. For retention, being with a non-biological caregiver (aOR = 0.325, 95% CI 0.111-0.9482 P = 0.04) decreased the odds. Meanwhile key barriers included: individual ones such as internal stigma and treatment/drug fatigue; facility-level such as prolonged waiting time and lack of social activities; community level include stigma and discrimination, inadequate social support and food shortage. In terms of facilitators, individual level ones included good adherence and knowledge of one's HIV status; facility-level such as provision of adolescent friendly services and community-level like social support and decent nutrition. Conclusions VLS rate was sub-optimal mainly due to poor adherence. HIV programs could utilize the barriers and facilitators identified to improve VLS. Conversely, retention rate at one year was good, likely due to provision of adolescent friendly health services. ALHIV and their caregivers need to be empowered to sustain retention and improve VLS.