Reaching the third 95 UNAIDS target in one of the largest HIV/AIDS treatment centers implementing an adolescent-centered approach in Cameroon

Background: Achieving the UNAIDS 95% sustained virological suppression rate requires considerable global efforts, particularly among adolescents living with HIV (ALHIV) who are often associated with high rates of virological failure. In this study, we prospectively assessed the rate of virological failure and the associated factors in a cohort of adolescents followed up according to the WHO guidelines in Cameroon 

Methods: A prospective cross-sectional assessment was carried out at the Laquintinie hospital of Douala (ACT/LHD), where multi-month (up to 3 months) dispensation, adolescents’ hub, high viral load register and extended adolescent-friendly service hours were routinely implemented. Adolescents (10-19 years) on ART for at least 6 months and followed up at the ACT/HLD between February and September 2021 were included in this study. Socio-demographic and clinical data were collected and a first viral load test (VL1) was measured using the ABBOTT Platform. For adolescents with VL1 >1000 copies/ml, adherence-enhancing interventions were performed each month for 3 consecutive months, after which a second viral load (VL2) was performed. Adolescents were considered in virological failure only if their VL2 > 1000 copies/ml. A stepwise-backward procedure was applied to identify factors independently associated with VF 

Results: Of the 280 participants enrolled, the majority (250/280, 89.3%) acquired HIV infection via mother-to-child transmission. The median age was 16.0 (IQR: 13.0-18.0) years, with almost no difference between girls and boys (p=0.99). One-half of the study participants were receiving ART for almost 10 years and only 72.5% had at least one viral load assessment conducted in the last 12 months before study initiation. The overall virological suppression rate was 88.9% (CI: 83.8%-91.7%). Following adherence-enhancing interventions, 26 out of the 57 adolescents (45.6%) with an initial viral load >1000 copies/ml achieved viral load suppression. Being on a second or third-line ART regimen (p=0.07), self-declared suboptimal adherence (p=0.043), and having a previous VL result ≥1000 copies/mL in the last 12 months (p=0.014) were independently associated with higher odds of virological failure. 

Conclusions: The low rate (11.1%) of virological failure we report in this study indicates that improving treatment outcomes of ALHIV in resource-poor countries is achievable if adequate conditions are implemented.