Background: Viral load suppression (VLS) indicates the effectiveness of national HIV treatment programs. The Swaziland HIV Incidence Measurement Survey (SHIMS2, 2016) shows that Swaziland has achieved the third 90 target set by the United Nations Joint Programme on HIV/AISDS (UNAIDS). However, program data suggests that the third 90 has not been achieved for all sub-populations. We assessed correlates of VLS among HIV+ participants 15+ to identify remaining unsuppressed sub-populations.
Methods: SHIMS2 used a two-stage cluster randomized design to attain a nationally representative sample. The national testing algorithm was used to determine HIV status and VLS was defined as HIV RNA < 1000 copies/ml. Prevalence of VLS among HIV+ persons was calculated using weighted analyses to account for complex survey design. Logistic regression was conducted using Jackknife variance methods.
Results: Seventy-two (72%) of all PLHIV were virally suppressed. Among 15,628 surveyed adults, 10,934 agreed to HIV testing, of which 3,003 (27%, 95% Confidence Interval (CI):25.7, 28.3) were HIV+, of these 65.5% were female and the median age was 37 years (Interquartile range (IQR): 30-47). A majority (87.4%, CI: 85.8-89.1) reported current ART use. Among those reporting ART use: VLS among those who had never married (87.5%, 95% CI: 84.6-90.4) was significantly lower compared to ever married (93.9%, CI: 92.7-95.2, p<.001). PLHIV were progressively more likely to be VLS with increasing age; compared to 15-24 year olds odds ratio [OR]=2.9 p<0.001 for 25-34 years, OR=4.4, p<.001 for 35-44 years and OR=8.3, p<.001). No significant difference in VLS by sex, region or education was observed. In multivariate modelling, controlling for sex and marital status, older participants still had higher odds of being VLS compared to 15-24 year olds, adjusted odds ratio [aOR]=2.3, p=0.003 for 25-34 years; aOR=3.5, p<.001 for 35-44 years and aOR=6.7, p<.001 for 45+ years.
Conclusions: Young PLHIV have lower odds of having VLS compared to older age groups. Though many factors influence VLS, including ART adherence, age is the most significant. It is critical that programs understand the needs of 15-24 year olds in order to close the gap in VLS, since this population will expand as the youth bulge ages.

Download the e-Poster