UNAIDS viral suppression target achieved: an evaluation of a viral load surveillance system at a Referral Laboratory, Nairobi, Kenya

Abstract

Objectives: To evaluate the viral load surveillance system to determine performance and identify areas for improvements and further  investigations.

Setting: National HIV Reference Laboratory (NHRL), Nairobi, Kenya.

Design: Cross-sectional study was conducted between 1st January 2019 and 28th February 2019.

Subjects: HIV infected individuals of all age groups who were on Antiretroviral Therapy for at least Six months and had a viral load test  done. Data collection and analysis: Patients records were abstracted from electronic medical record, cleaned, and analysed. Continuous  variables were summarized using measures of central tendency and dispersion whereas categorical variables summarized using  frequencies and proportions. Logistic regression model was used to evaluate the association between sociodemographic variables and  viral non suppression.

Results: A total of 47,155 patient records were retrieved, 68.5% were female and 45.3% were in the age-group of  20–39 years. Nairobi County referred 84.6% of the samples. Overall, viral suppression rate was 92.1%, female registered suppression rate  of 92.3% and male recorded 91.7%. Children recorded suppression rate of 82.5%, adolescents 80.1% and older adults (60+ years) registered 95.6%. The odds of virological non – suppression in children and adolescent was five and six times the odds among adults  aged 60+ years respectively (AOR= 5.2; 95% CI; 4.02 - 6.82, p = < 0.001 and AOR= 5.7; 95% CI; 4.46 - 7.18, p= < 0.001) . System was timely;  (median turnaround time =15, IQR=10 days). System acceptance was 98.9%, while flexibility was 100%. 4.46 - 7.18

Conclusion: Overall,  viral suppression rate was above UNAIDS 90-90-90 target. Being a Child and Adolescent was significantly associated with virological non –  suppression. The system was timely, highly flexible, and fully accepted.