Adherence to Antiretroviral Therapy by Medication Possession Ratio and Virological Suppression among Adolescents and Young Adults Living with HIV in Dar es Salaam, Tanzania

Abstract

Background: Adherence to antiretroviral therapy (ART) is a strong determinant of virological suppression. We aimed to determine the magnitude of adherence as measured by medication possession ratio (MPR) and virological suppression with its predictors among adolescents and young adults (AYA) living with HIV on ART in Tanzania. Methods: This retrospective cohort study was conducted using archived data from HIV care and treatment centers in Dar es Salaam, Tanzania between 2015 and 2019. The logistic regression model assessed predictors for adherence and virological suppression. Results: Data of 5750 AYA living with HIV were analysed. The majority were females: 4748 (82.6%). About 63% had good adherence with MPR ≥ 85% at one year post ART initiation. Independent predictors of ART adherence were male sex (aOR = 1.3, 95% CI 1.1–1.5), CD4 > 500 cells/mm3 (aOR = 0.7, 95% CI: 0.6–0.9), WHO stage III (aOR = 1.6, 95% CI 1.3–1.9), enrollment in 2019 (aOR = 1.5, 95% CI 1.2–1.9), and virological suppression (aOR = 2.0, 95% CI 1.6–2.9). Using an Efavirenz- and a Nevirapine-based combination was associated with reduced odds of ART adherence (aOR = 0.3, 95% CI 0.1–0.8) and (aOR = 0.2, 95% CI 0.1–0.6), respectively. Predictors of virological suppression were MPR ≥ 85% (aOR = 2.0, 95% CI 1.6–2.4); CD4 > 500 cells/mm3 (aOR = 2.4, 95% CI 1.7–3.4), and once-daily dosing (aOR = 2.0, 95% CI 1.3–2.5). Conclusion: Adherence to ART among AYA living with HIV is suboptimal. Sex, year of enrollment, ART drug combination used, and immunological status at ART initiation are important predictors of adherence to ART and virological suppression.