Treatment outcomes among adolescents on antiretroviral therapy in Machakos, Kenya

Abstract

It is estimated that in 2017 there were about 1.5 million people living with Human immunodeficiency virus (HIV) in Kenya, of which 105,000 (7%) were adolescents. Adolescents have poorer antiretroviral therapy (ART) outcomes compared to adults. This study aimed to determine the treatment outcomes of adolescents on ART in Machakos County, Kenya. Adolescents on ART for at least two years from nine facilities were randomly selected in this retrospective cohort study. Data on their clinical and laboratory information at baseline and follow-up were abstracted from patient files. Descriptive analyses were used for central tendency while univariate and multivariate analysis was performed using SPSS version 16.0. A total of 182 adolescents consisting of 102 (56%) females and 80 (44%) males participated in the study. There were 54 (29.7%) young adolescents aged 12-15 years and 128 (70.3%) older adolescents (over 15 years). A total of 119 (65.4%) adolescents were retained after a mean follow-up period of 34.5 months. Almost all [180 (98.9%)] the adolescent had their weight and height documented, 143 (78.6%) had at least one viral load test, 140 (76.9%) at least one CD4 test and 164 (90.1%) had TB screening at the last visit. At first viral load test, 73% of adolescents were virally suppressed while 4.9% died in the course of follow-up. Additionally, 16.5% of adolescents were lost-to follow-up; 10.4% were transferred out, 20.3% had a treatment interruption and 6.6% were switched to second line treatment. Older adolescents had worse treatment outcomes compared to younger adolescents. They had lower retention rates; 60.2% compared to 77.8%; lower viral suppression: 70.4% compared to 75.6% and higher mortality: 6.3% compared to 1.9%. Suboptimal treatment outcomes were found despite good clinical follow-up, which were worse in the older adolescents. There is an opportunity to improve adolescent HIV treatment to meet national and global goals. Key words: Treatment outcomes, antiretroviral therapy, adolescents, human immunodeficiency virus (HIV), Machakos, viral suppression, Kenya.