Review of the National AIDS and Sexually Transmitted Infections Case-Based Surveillance system for viral suppression among HIV positive women of reproductive age, Western Kenya, 2021

  • Sexually Transmitted Diseases
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Globally, the 2020 UN targets of 90:90:90 projected that 90% of patients started on Antiretroviral therapy achieve HIV viral suppression (<400 copies) monitored routinely using Viral load test. We evaluated the CBS system for the viral suppression among HIV positive women of reproductive age (15–49years old) on ART since Kenya is among priority countries for validation of elimination of Mother-to-Child Transmission of HIV & Syphilis.

We retrospectively reviewed records from Case-based surveillance (CBS) system in three HIV high burden sub-national levels in April 2021. Revised CDC guidelines were used to evaluate the following attributes; Representativeness, simplicity, completeness and timeliness. Descriptive, bivariate and multivariate analysis of age, drug regimen and regimen line were conducted with odds ratios determined for association with viral suppression.

The CBS system is real time obtaining data from Electronic Medical Record systems used in 41% of the facilities (1493/3650) with completeness, reporting rate and timeliness at 87.6% and 84% respectively. We reviewed 119,109 records: mean age was 35 years (± 7.9) with viral suppression of 95.5%. Age group 15–24 years had the lowest viral suppression at 90.7%. Women on TDF/3TC/DTG and AZT/3TC/DTG had highest and lowest viral suppression rates of 98.4% and 66.8% respectively. Suppression on 1st line was 95.8% while 2nd line was 88.6%. The odds of Viral suppression were 6 times higher among women on TLD compared to other ART regimens (aOR: 6.17, 95% CI: 5.77–6.60). Other associations were observed in those above 25 years of age and being on 1st line regimen (aOR: 1.95, 95% CI: 1.82-2.11) and (aOR: 1.17, 95% CI: 1.08-1.28) respectively.

Representativeness, simplicity, completeness and timeliness were good. Viral suppression surpassed UN targets though lower for those aged 15–24 years and those on 2nd line. We recommend TLD optimization amongst adolescents and young women.

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